Laying the IT Foundation for ACOs


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Medical Device Integration

CMIOs and MU

First-Day Attestation

July 2011

Volume 28, Number 7

Risk or Reward?

www.healthcare-informatics.com

Laying the IT Foundation for ACOs

Tame the beast. What’s lurking in your strategic path? Is it the cost and headaches of ANSI 5010 and ICD-10 conversion? Or the Meaningful Use hurdle that lies ahead? Or the hit your balance sheet’s about to take from a massive software upgrade? Whatever combination of risks and challenges you’re facing, we have a solution for bringing things under control. Our flexible cloud-based practice management, EHR, and patient communication services will help you navigate every change and seize every opportunity to come. And with our low up-front costs, your balance sheet can stay safe from harm. Beast tamed.

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MORE MONEY

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񡑉񡑕񡑕񡑀񡑥񡑧񡑤񡑔񡑰񡑓񡑩񡑀񡑔񡑕񡑢񡑤񡑣񡑨񡑩񡑧񡑑񡑩񡑙񡑤񡑣񡑨񡑀񡑑񡑩񡑀񡑄񡑖񡑠񡑑񡑘񡑅񡑣񡑙񡑠񡑑񡑕񡑙񡑤񡑉񡑗񡑕񡑥񡑁񡑐񡑡񡑇񡑖񡑉񡑑񡑐񡑧񡑦񡑆 )񡑀.,−−񡑀񡑆񡑣񡑩񡑕񡑧񡑉∀񡑨񡑩񡑕񡑢񡑨񡑀񡑂񡑤񡑧񡑥񡑤񡑧񡑑񡑩񡑙񡑤񡑣&񡑀񡑁񡑡񡑡񡑀񡑧񡑙񡑗񡑘񡑩񡑨񡑀񡑧񡑕񡑨񡑕񡑧񡑱񡑕񡑔&񡑀񡑆񡑣񡑩񡑕񡑧񡑉∀񡑨񡑩񡑕񡑢񡑨񡑀񡑃񡑣񡑨񡑕񡑢񡑒񡑡񡑕񡑀񡑑񡑣񡑔񡑀񡑆񡑣񡑩񡑕񡑧񡑉∀񡑨񡑩񡑕񡑢񡑨񡑀񡑂񡑑񡑓񡑘#񡑀񡑑񡑧񡑕񡑀񡑧񡑕񡑗񡑙񡑨񡑩񡑕񡑧񡑕񡑔񡑀񡑩񡑧񡑑񡑔񡑕񡑢񡑑񡑧񡑠񡑨񡑀񡑤񡑖񡑀񡑆񡑣񡑩񡑕񡑧񡑉∀񡑨񡑩񡑕񡑢񡑨񡑀񡑂񡑤񡑧񡑥񡑤񡑧񡑑񡑩񡑙񡑤񡑣&񡑀񡑆񡑣񡑩񡑕񡑧񡑉∀񡑨񡑩񡑕񡑢񡑨񡑀񡑅񡑕񡑑񡑡񡑩񡑘񡑉񡑘񡑑񡑧񡑕񡑀񡑙񡑨񡑀񡑑񡑀񡑩񡑧񡑑񡑔񡑕񡑢񡑑񡑧񡑠񡑀񡑤񡑖񡑀񡑆񡑣񡑩񡑕񡑧񡑉∀񡑨񡑩񡑕񡑢񡑨񡑀񡑂񡑤񡑧񡑥񡑤񡑧񡑑񡑩񡑙񡑤񡑣&񡑀/∋−−񡑀񡑁񡑔񡑱−,񡑅񡑕񡑆񡑣

CONTENTS July DEPARTMENTS 4

INSIDE EDITOR’S PAGE

6

MEETING THE TOP CLINICAL IT CHALLENGES What happens when you gather some of the smartest, most innovative healthcare leaders in the same room to discuss the future? Highlights of the very first HCI Executive Summit

FINANCIAL MANAGEMENT

28

SMALLER MARGINS, CLEAR FUNDAMENTALS With their smaller size and limited business and IT staffs, medical groups are often behind hospitals when it comes to applying the most advanced revenue management strategies. The leaders of the 480-provider WellSpan Medical Group explain why its investment in RCM solutions has been worthwhile BY MARK HAGLAND

COVER STORY 8

CLINICAL PERSPECTIVE

31

The release of the proposed rule for Accountable Care Organizations in March created a torrent of comments, interest and concerns across the healthcare industry. Now that the dust has begun to settle, the experiences of intrepid provider leaders can provide some insight into going forward

BY MARK HAGLAND

14

CLINICAL PERSPECTIVE

34

POLICY PERSPECTIVE

36

BY JOHN DEGASPARI

22

BY MARK HAGLAND

FIRST-DAY ATTESTATION FOR TEXAS HEALTH RESOURCES Among the very first integrated health systems to attest under meaningful use is Texas Health Resources. CMIO Ferdinand Velasco, M.D., shares his experience BY MARK HAGLAND

CMIOs AND PERSUASION PRINCIPLES It takes a team to lead provider organizations through the arena of quality reporting under meaningful use. What strategies are CMIOs following to get their clinician, IT and administrative colleagues on board?

BEACON COMMUNITIES REACH MILESTONE Achievements and challenges are discussed as grantees marked the one-year anniversary of the program BY JENNIFER PRESTIGIACOMO

MEDICAL DEVICES: GROWING PAINS Recent strides in both the regulatory and standards arenas have brought the goal of integrating disparate medical devices in the hospital closer to reality, resulting in better security and quality of patient data

INNOVATION IN THE eICU Cecilee Ruesch, R.N., winner of the first Healthcare Informatics/AMDIS IT Innovation Advocate Award, shares her experience with the creation of a nurseled electronic intensive care unit system at the 320provider Providence Alaska Medical Center BY MARK HAGLAND

ACOs: RISK OR REWARD?

CAREER PATHS

40

COPING WITH THE REAL ESTATE BLUES Short-term solutions to help potential hires deal with relocation issues in a down market BY TIM TOLAN

Healthcare Informatics (ISSN 1050-9135) is published monthly by Vendome Group, LLC, 149 Fifth Ave, 10th Floor, New York, NY 10010. Periodicals postage paid at New York, NY and additional mailing offices. POSTMASTER: send address changes to HEALTHCARE INFORMATICS, P.O Box 2178, Skokie, IL 60076-7878. Subscriptions: For questions or correspondence about a subscription, phone 847-763-9291 or write to HEALTHCARE INFORMATICS, PO Box 2178, Skokie, IL 600767878. If you are changing your address, please enclose entire mailing label and allow 6 to 8 weeks for change. Subscription rate per year (U.S. Funds): U.S. $58.00; Canada/ Mexico $82.00; all other countries $109.95 (includes air delivery). Single copy rate (U.S. Funds) except JULY and January: U.S. $8.00; Canada/Mexico $12.00; all other countries $15.00. JULY 100 and January Resource Guide: $50.00 (U.S. Funds) includes shipping/handling to all countries. Add state and local taxes as applicable. 2 July 2011 • www.healthcare-informatics.com

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Healthcare

Informatics

INSIDE

Healthcare IT Leadership, Vision & Strategy

ACOs, Medical Devices, MU Teamwork, First-Day Attestation

W

ith the release of the proposed rule for accountable care organizations, providers are moving ahead on their ACO initiatives. This month’s cover story, beginning on page 8, explores the opportunities and risks involved, as the experiences of leading organizations point the way forward. The article on page 14 takes a look at the progress being made by hospitals and vendors in the area of medical device interoperability. There has been real movement by both regulators and standards organizations that are providing new impetus to make disparate medical devices work as a system, resulting in better patient safety. Meanwhile, the feature story on page 22 takes an inside look at meaningful use—that is, what strategies are CMIOs following to get their clinician colleagues fully on board as they lead their organizations through the complex area of quality data reporting. This month’s financial management coverage, on page 28, focuses on revenue cycle management in the medical group environment, as the leaders of the 480-provider WellSpan Medical Group, explain why their investment in RCM solutions has been worthwhile. On page 31, Cecilee Ruesch, R.N., shares her experience as team lead at Providence Alaska Medical Center for the development of a nurse-staffed remote monitoring system via a new electronic intensive care unit system. The project was the first-place winner of the first Healthcare Informatics/AMDIS IT Innovation Advocate Award, presented in May. In addition, the Beacon Communities Program reached its one-year anniversary in May, which was marked by an event co-sponsored by the Brookings Institution and the Office of the National Coordinator for Health IT. The story on page 34 highlights the progress that has been made, as well as the challenges that remain. On page 36, Ferdinand Velasco, M.D., CMIO of Texas Health Resources, shares his experiences regarding his organization’s attestation under meaningful use. THR is among a small number of integrated health systems to complete the attestation process on April 18, the first day in which attestation of the fulfillment of Stage 1 requirements under the HITECH Act was possible. Last but not least, on page 40, HCI Career Paths columnist Tim Tolan offers solutions to help potential hires deal with relocation issues in a lethargic housing market.

EDITORIAL EXECUTIVE DIRECTOR OF EDITORIAL INITIATIVES Charlene Marietti [email protected] EDITOR-IN-CHIEF Mark Hagland [email protected] MANAGING EDITOR John DeGaspari [email protected] ASSOCIATE EDITOR Jennifer Prestigiacomo [email protected] SENIOR CONTRIBUTING EDITOR David Raths [email protected]

SALES GROUP PUBLISHER MIDWEST & WEST COAST ACCOUNTS Nicole Casement [email protected] 212-812-8416 SALES DIRECTOR/EAST COAST ACCOUNTS Chris Driscoll [email protected] 212-812-8427 PRODUCT WATCH/RESOURCE GUIDE SALES Alexandra Bonanno [email protected] 212-812-1415

CIRCULATION CUSTOMER SERVICE/SUBSCRIPTIONS 847-763-9291 • [email protected]

PRODUCTION DIRECTOR OF PRODUCTION Kathi Homenick [email protected] ART DIRECTOR James Gouijn-Stook [email protected] TRAFFIC MANAGER Judi Zeng [email protected] 212-812-8976 All ad materials should be sent to: https://vendome.sendmyad.com

CUSTOM REPRINTS and E-PRINTS

2011 EDITORIAL BOARD Marion J. Ball, Ed.D. Professor, Johns Hopkins School of Nursing Fellow; IBM Center for Healthcare Management; Business Consulting Services, Baltimore Lyle L. Berkowitz, M.D., FHIMSS Medical Director, Clinical Information Systems Northwestern Memorial Physicians Group, Chicago William F. Bria II, M.D. CMIO, Shriners Hospital for Children, Tampa, Fla. Adjunct Associate Professor, University of Michigan Tina Buop CIO of Clinical Integration, Muir Medical Group, Walnut Creek, CA Bobbie Byrne, M.D. VP for HIT, Edward Hospital, Naperville, IL Erica Drazen, Sc.D. Vice President, Computer Sciences Corporation, El Segundo, CA Suresh Gunasekaran CIO, University Hospitals, UT Southwestern Medical Center, Dallas W. Reece Hirsch Partner, Morgan, Lewis & Bockius LLP, San Francisco

4 July 2011 • www.healthcare-informatics.com

Christopher Longhurst, M.D. CMIO, Lucile Packard Children’s Hospital, Clinical Assistant Professor of Pediatrics, Stanford University School of Medicine, Palo Alto, CA Chuck Podesta SVP and CIO, Fletcher Allen Health Care, Burlington, VT Stephanie Reel Vice President and CIO, Johns Hopkins Health System, Baltimore Wes Rishel VP and Research Area Director, Gartner Healthcare, Industry Research and Advisory Services, Alameda, CA Benjamin M.W. Rooks Principal, ST Advisors, LLC, Evanston, IL Rick Schooler Vice President and CIO, Orlando Health, Orlando, FL Patricia Skarulis Vice President and CIO, Memorial Sloan Kettering Cancer Center, NY Lynn Witherspoon, M.D. System Vice President and CMIO, Ochsner Health System, New Orleans

Donna Paglia 216-373-1210 • [email protected]

REUSE PERMISSIONS Copyright Clearance Center 978-750-8400 • [email protected]

CORPORATE CHIEF EXECUTIVE OFFICER Jane Butler EXECUTIVE VICE PRESIDENT Mark Fried CHIEF FINANCIAL OFFICER Mike Muller EXECUTIVE GROUP PUBLISHER Michael W. O’Donnell HEALTHCARE MARKETING DIRECTOR Rachel Beneventi www.vendomegrp.com © 2010 by Vendome Group, LLC. All rights reserved. No part of Healthcare Informatics may be reproduced, distributed, transmitted, displayed, published or broadcast in any form or in any media without prior written permission of the publisher.

EDITOR’S PAGE

Meeting the Top Clinical IT Challenges HIGHLIGHTS FROM THE HEALTHCARE INFORMATICS EXECUTIVE SUMMIT

W

hat happens when you bring together some of the smartest, most innovative CIOs, CMIOs, policy leaders, and industry experts in healthcare, and put them into the same room, to talk about the future? You get some of the most satisfying discussions possible in this current environment of rapid change and uncertainty. And that’s just what happened in San Francisco, May 11-13, when we at HCI were fortunate enough to be able to gather Mark Hagland together some of the most thoughtful healthcare IT leaders nationwide, for our first-ever Healthcare Informatics Executive Summit. And what emerged were trenchant discussions of some of the trickiest, most complicated issues facing healthcare IT leaders nationwide right now. Among the numerous issues our panelists parsed out: Some of the “hidden,” scarcely understood, data quality reporting requirements under meaningful use under the federal HITECH Act; What kinds of reporting relationships and team structures ensure the operational success of clinical informaticist teams, across a variety of different organizational structures; The immense complexities involved in laying the IT infrastructure foundation not only for meaningful use, but also for accountable care organization, patient-centered medical home, bundled payment, and other innovative payment arrangements and structures. Among the many revelatory moments during the Summit were these: Dan Martich, M.D., explaining how the success of his clinical informaticist teams at the UPMC health system rests on nearly two decades of multidisciplinary collaboration and teamwork; Bill Spooner of Sharp HealthCare describing numerous years of planning and foundation-laying in terms of clinical IT infrastructure, as adequate preparation for moving forward rapidly now to meet the requirements of meaningful use; 6 July 2011 • www.healthcare-informatics.com

Jane Metzger of the Emerging Practices division of CSC explaining in riveting detail the huge gaps between the ostensible quality data reporting requirements under meaningful use, and their actual complexity, as in the case of the “single” requirement around the documentation of VTE prophylaxis provision, and its multilayered reality, which involves eight different types of VTE prophylaxis, and implicates six or more clinical information systems in hospital organizations; Industry-leading executive recruiters Linda Hodges and Tim Tolan talking about the dramatic changes taking place now regarding the growing gap between what hospital organizations are looking for in CIO and CMIO candidates, and what kinds of candidates the market is currently producing. We were also very fortunate to have opening and closing keynote speakers of the exceptional stature of Farzad Mostashari, M.D., the national coordinator for health IT, and Carolyn Clancy, M.D., who has spent years enhancing the scope and range of the Agency for Healthcare Research and Quality (AHRQ). Dr. Mostashari’s opening keynote address was noteworthy for its passion and optimism, while his core theme—that the meaningful use process is working well, and that hospitals and physicians are proving the MU naysayers consistently wrong, was well-received by his audience. And Dr. Clancy’s explication of the considerable—and, may I say, little understood—range of activities, outreach, and funding at AHRQ—also impressed her listeners, and provided attendees with valuable new information. It was very satisfying to help lead the hosting of the first-ever HCI Executive Summit, and deeply gratifying to be able to share in its success with all the speakers, panelists, and participants at the Summit—the people who made the Summit a successful event. And we at HCI look forward to developing future summits. Given the wonderful healthcare IT leaders who are good friends of HCI, we’re very optimistic going forward. Please stay tuned!

Mark Hagland Editor-in-Chief

One hospital estimated

$

6.8

MILLION SAVED annually in

adverse drug events1

IV Clinical Integration helps reduce medication errors through fewer manual steps. The numbers don’t lie. IV Clinical Integration enhances patient safety, staff efficiency and your institution’s financial position through integrated programming and real-time documentation. As the most experienced provider of IV Clinical Integration, Hospira is committed to giving you and your staff the knowledge, expertise and support to help you set new standards in IV drug delivery workflow.

To see IV Clinical Integration in a live setting, scan this code with your mobile device or go to http://hospiramobile.com/ivclinicalintegration. For more information, call 1-800-237-5512.

Reference: 1. Ford D, Luttrell N. Leadership in patient safety: IV pump auto-programming. Presented at Cerner Health Conference; October 2009. Hospira, Inc., 275 North Field Drive, Lake Forest, IL 60045

P11-3131C-Apr., 11

COVER STORY

Risk or Reward? LAYING THE IT FOUNDATION FOR ACOs PRESENTS DAUNTING CHALLENGES FOR HEALTHCARE LEADERS NATIONWIDE BY MARK HAGLAND

EXECUTIVE SUMMARY: Industry experts and healthcare IT leaders agree that the recently released proposed rule on the creation of accountable care organizations (ACOs) is offering a heady mix of opportunity and risk, and that laying the IT foundation for success under ACO initiatives will be massively challenging for the vast majority of patient care organizations nationwide. Those a bit further along on the journey say that interoperability, connectivity, and the leveraging of clinical IT for intensive care management and data analysis will be essential to ACO success.

O

n March 31, when the federal Centers for Medicare and Medicaid Services (CMS) released its proposed rule for accountable care organization (ACO) development under federal healthcare reform, it unleashed a torrent of comment, interest, and concern across the healthcare industry. In releasing the proposed rule, CMS both fulfilled an explicit require-

non-payment for healthcare-acquired infections and conditions and “never” events, the creation of the voluntary ACOs program points towards a healthcare reimbursement system moving rapidly away from no-strings fee-forservice payment for hospital and other services, and towards a system strongly modified in favor of various contingencies around payment. And while many provider leaders are interested in becoming involved in the Medicare shared savings program around ACOs—and in many cases, shared-savings programs in the commercial health insurance market, as well—many expressed some alarm, following the March 31 proposed rule release, at some of the elements in the proposed rule. These include elements around payment itself (most especially the downside risk elements in the “twosided risk” model being offered alongside a “one-sided risk” model) and in the level of information technology and data management challenges involved.

tivity requirements appear daunting to many in patient care organizations.

MORE THAN SIMPLE EHR IMPLEMENTATION All aspects of ACO development will prove challenging if the specific requirements of the proposed rule remain in place in later stages, says Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.based American Medical Group Association (AMGA). In terms of the level of nationwide physician group preparation for ACO development, Fisher says, “I think it runs the gamut; the very small solo practices and smallest groups are simply not ready. But some of the larger multidisciplinary medical groups that have a significant enough primary care base and relationships with hospitals, and that have some level of electronic health record, and some experience with population health management, and are looking beyond one-patient-ata-time episodic care, are more ready.” That being said, he emphasizes that “As far as the electronic health record, it’s not just having an EHR that stores patient information isn’t sufficient,” Fisher notes; “you’ve got to be able to get into your electronic health record and create disease registries, help [patients]

YOU’VE GOT TO BE ABLE TO GET INTO YOUR ELECTRONIC HEALTH RECORD AND CREATE DISEASE REGISTRIES, HELP [PATIENTS] MANAGE THEIR DISEASES, BE ABLE TO INTERVENE TO PREVENT EMERGENCY DEPARTMENT VISITS. —DONALD W. FISHER, PH.D. ment under the Accountable Care Act (ACA), the federal healthcare reform legislation passed in March 2010, and also signaled to the industry its intentions around one major element of reimbursement reform. Indeed, taken together with new mandates around value-based purchasing, readmissions reduction, and 8 July 2011 • www.healthcare-informatics.com

For example, under the proposed rule, 50 percent of physicians participating in any ACO would have to be “meaningful users,” as defined by the Health Information Technology for Economic and Clinical Health (HITECH) Act, a requirement that many provider executives consider unrealistic in the short term. What’s more, the interoperability and connec-