CIOs: Changing Times, Changing Roles

In July, CMS published the final rule for Stage 1 of meaningful use requirements. All the programs will begin in 2011 and many healthcare CIOs have a new task to add to their already crammed schedules: Rallying their physicians to come into compliance sooner rather than later. CMIO spoke with three CIOs about their evolving role in practice management in this new era of meaningful use.

“I believe it is the modern CIO’s responsibility regarding strategy and innovation to aggregate as much momentum from physicians, both employed and private, to help them get to a level of functionality that enables them to practice medicine and create revenue,” says Russell P. Branzell, FCHIME, CHCIO, vice president of IS and CIO, Poudre Valley Health System.

Poudre Valley Health System, based in Fort Collins, Colo., provides a regional network of healthcare services for northern Colorado, southern Wyoming and western Nebraska. Its two acute-care hospitals (281 and 136 beds) and affiliated practices and clinics employ more than 200 physicians and 4,000 employees. All of Poudre Valley Health System’s IT is centralized under one information system shop, says Branzell.

CIOs should ensure that practices are collaborating with the right organizations, such as state-designated entities like Colorado Regional Health Information Organization, which is charged with developing a statewide system of health information exchange (HIE), supporting communities’ efforts to create HIEs and consulting with practitioners who want to use healthcare IT.

“It’s more than supplying hardware and software solutions,” Branzell says. “It’s also about helping physicians and practices understand the rules of the game so they can make informed decisions. We don’t want them to invest in a system that will come up short for Stages 2 and 3 of meaningful use requirements.”

Poudre Valley has had an EMR integration strategy in place for the past six years. All employed physicians, even newly acquired practices, use a standard EMR from Meditech. Although some private physicians are choosing to use that solution, others want a separate one, says Branzell.

“We try to support them as much as we can. But they have to understand their responsibilities regarding connecting with out-of-state HIEs and the requirements for integration in the later phases of meaningful use that will mandate improved outcomes. Part of my job is educational, and part of it is advocacy,” he says.

“As much as possible, we are working for everyone to have the same standards and protocols, but where they choose to differ, we want to ensure that they can,” Branzell says.
 

EMRs and motivation

Henry County Health Center is a critical access hospital in Mount Pleasant, Iowa, with 23 licensed beds and a 49-bed long-term care unit. The center has 350 FTEs, including nine employed physicians, five of whom are in the emergency room. On campus is an independently owned, 14-physician family internal medicine practice that contracts administrative and IT services from the hospital.

Henry County Health Center CIO Stephen M. Stewart, MBA, FACHE, CPHIMS, CHCIO, is charged with the support and implementation of EMR systems and attaining meaningful use for both the family medicine group and the hospital-employed physicians. “We’re very close to achieving that,” he says.

Most of the quality measures for meaningful use have been in place since 2001 in the family medicine practice and since 2004 in the hospital when each converted to an EHR—CPSI Systems’ CPSI in the clinics and GE Healthcare’s Centricity in the hospital. The hospital has been reporting 19 of the 34 measures that are now required for meaningful use, he says. But before any game-changing technology can be implemented, physicians and staff have to be on board.

“It has to start with a fundamental belief that this will produce better outcomes in the long run,” Stewart says. “From there, you design processes that are minimally intrusive on physicians’ time.”

Getting physicians to help design such processes can be challenging. Stewart and his team solved that problem by hiring certain physicians and staff as paid consultants. They assembled a core group of four people, including the IT director, who were heavily involved with the design and implementation of the EHR. “It has paid off handsomely,” Stewart says.

While the family medicine practice is independently owned, its contractual agreements with the hospital give Stewart a “great deal of observational oversight,” he says. Even so, the key for Stewart to lead the charge is his ability to present the business case for meaningful use and let the physicians make the decision.

“You don’t direct physicians; you persuade them with facts,” he says.
 

‘We have our work cut out for us’

St. Claire Regional Medical Center, a 159-bed regional referral center in Morehead, Ky., is the second largest employer in the region, with nearly 1,300 employees including 100 physicians. St. Claire Regional comprises five family medicine clinics, an outpatient facility, an independent surgical group and several other affiliated clinics.

Randy McCleese, CHCIO, FHIMSS, vice president of IS and CIO, is a big proponent of involving physicians in the decision-making process from the very beginning. When the hospital installed a document imaging system, the focus was on “trying to avoid building another structure to house records, not on how user-friendly the system was,” he says. There has been resistance to the system for the past three years since go-live and as part of the acute-care EMR implementation, that system is being replaced, McCleese says. “It was a huge mistake for us not to involve the people who have to use the technology day in and day out.”

McCleese encourages CIOs to identify physician champions among their ranks. “In my case, that person identified himself and has been very influential in our IT initiatives. He has the demeanor to work with physicians one-on-one, regardless of the specialty.”

When St. Claire Regional installed an Allscripts EMR in the primary care clinics, it was with the help of a four-person project management team. The implementation of the Meditech acute-care EMR is being guided by a team of eight: An IT pro, who also serves as the project coordinator; the CMIO; a radiologic technologist; a pharmacist; the director of financial services; the director of health information management; the director of nursing; and McCleese.

He expects the primary care organizations to achieve Stage 1 meaningful use compliance by 2011, but acute care is a different story. When the HITECH Act was passed last year, the center decided to replace its best-of-breed environment with one primary vendor, with a few add-ons.

The CPOE portion will go live in late 2012, allowing St. Claire Regional to qualify for incentive funding in 2013. “We have our work cut out for us,” McCleese says.

He meets on a daily basis with his project management team to ensure the EMR is on schedule. They have encountered resistance from some sectors that don’t want to give up their best-of-breed systems. When those issues arise, the St. Claire Regional executive team—comprised of the vice presidents, the CEO, CFO, CMIO, clinic director and other key leaders—then asks the question: What is best for the organization?

One example is the hospital’s 16 different areas for scheduling, which were mostly paper-based. The implementation team agreed that one system would be cost-effective, but expected resistance. The members took their concerns to the executive team, which had to intervene in some instances.

“It took a lot of consensus-building and communication,” McCleese says. “I have an excellent team that understands all the aspects of the entire organization, as well as their individual contributions. That type of teamwork is crucial for moving forward in meaningful use compliance.”