Q&A: Demonstrating the power of data
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Your organization started with a single-vendor implementation plan. What made you decide to take a multivendor, multisystem EHR approach?
About two years ago, we started to look for a multivendor solution because it was clear that a single-vendor solution [could take] years to get running. We didn’t feel like we had that much time. [Also,] our existing hospital information system was a closed, proprietary system that did not make it easy for data to flow into and out of the system.
We have 300 doctors in our physician group who provide 1 million outpatient encounters a year at 50-plus access points. We also have a purchasing program called PedsPal which includes more than 2,500 doctors in 29 states. We wanted to find an [affordable] EMR for them, because they’re mostly small practices.
Data strategy was also part of the decision. We started working with athenahealth to see if it would work with PedsPal. We had a demonstration of athenahealth’s cloud-based services in 2009, [and the doctors] began to ask for it for themselves. Ultimately, our CEO agreed to let docs choose athenahealth for practice management and their EHR. However, the hospital didn’t want to leave Meditech, so we found Microsoft Amalga. This combination gave us the ability to choose the vendor and product that the doctors wanted, to keep product that the hospital wanted and blend data across ambulatory and inpatient care settings through Amalga.
Was implementation a phased-in process or all at once?
On Feb. 1, 2010, we brought 1,024 users live on athenahealth—the entire practice management of the organization, plus the EHR for all primary care physicians, which is about 100 doctors. We went live in less than a year across the enterprise. Other [organizations have gotten] hung up in their EHR adoption—sometimes to the point where it comes to a stop. Now other organizations are adopting “the Cook Strategy” to get unstuck and into the cloud.
What did you do to ensure physician adoption?
A lot of their enthusiasm is based on faith—the good stuff doesn’t happen until you have a lot of data in the system. We haven’t really implemented a lot of gee-whiz tools yet. We are working with Microsoft to create a consolidated patient view with immunization status, problem list, recent diagnostic tests, allergies, whatever the key indicators are for the ER physicians—that will come up on one screen. That will increase the throughput of the ED dramatically.
A little more than a year after deployment, what results have you seen?
Practice management has improved to 23 days in [accounts receivable], on $220 million of gross billing for 400 providers.
All physicians using the EMR tie back to a single instance of software, so when it changes, everybody gets those advantages.
Is it perfect? No. Some doctors still bemoan the fact that they don’t have paper charts because they miss, to some degree, what they think they remember was good about paper charts. Memory works that way. We still have 100 percent adoption across all subspecialties.
Is Cook Children’s leveraging this connectivity for data sharing or analytics?
This has started to unlock some collaborative efforts that are going to be incredibly important. Because we buy so much vaccine through our purchasing program, we’re able to bring competitors together sometimes. [When the] FDA agreed that 2-D barcoding would be acceptable, we worked with vendors on 2-D barcode standards. We expect to be able to demonstrate barcodes for vaccines that can be auto-populated into athena later this year. The next step will be a replenishment protocol that will give vaccine manufacturers the ability to know inventory status within physicians’ offices and to better match supply with community needs.
What data is exchanged now?
We’re flowing demographics, lab data … [we have] 10 to 15 live feeds now, including home health data. A feed can be a little bit of information or a lot, depending on the source. Amalga is a 3-D SQL database that’s unstructured until the data are needed, [then its] parsing script transforms the data at a point when both the data and its use are better understood. Amalga … holds data in the repository until you come in and ask for specific information. You can drill down, expand it, contract it. … You can de-identify the data, so it’s a phenomenal research tool.
Looking ahead, how will you use this information?
Later this year, we’re aiming to [look] at how vaccines are reimbursed nationally by payors because one of the problems we see with PedsPal affiliates is that they work at an extremely low financial margin. They don’t have great leverage, so they get squeezed. Because athena can consolidate data, they can look across the universe of all clients, all vaccines given and all reimbursements received, to identify any sort of trend that might be apparent across payors. Do they pay fairly? Nobody’s ever looked at that.
The CDC posts the average retail acquisition price for vaccines for providers, and we’re going to benchmark against that to see if physicians are being appropriately reimbursed against their acquisition cost for vaccines by the payors. It’s the most important money spent in healthcare and if they’re not doing it, then they need to come under pressure to start paying for vaccines.
We’re going to begin to make the value of data obvious for public health.