Hot Horizons: CMIOs Look to the Near Future

Brian Patty, M.D., CMIO, HealthEast Health System: We’re in the middle of switching EHR vendors, so that’s first and foremost on my list right now. The other ones for me are continuing to hit on meaningful use, though we’ve pretty much gotten it down now, so it’s just making adjustments; and the ICD-10 transition. ICD-10 is a big, looming issue. And the other is making sure our EHR is serving us to meet the needs of healthcare reform, especially the ACO [accountable care organization] market, and the continuum of care. Within the area of initial initiatives around where we can reduce cost, one of the biggest areas is around unnecessary readmissions. In the current world, we get paid for those; in the future world, those will hurt us. We’re looking at strategies to reduce unneeded readmissions, and that ties into the ACO strategy.

TACKLING READMISSIONS

HCI: Dr. Patty, your organization is a Medicare Shared Savings Program ACO. How hard has work on readmissions and ACO development been so far?

Patty: Readmissions are tricky. We obviously look at the top chronic diseases, like CHF [congestive heart failure], heart disease in general, and total joints [total joint replacement surgeries]. Diabetes plays into all of those, of course, as a readmissions risk factor. We’ve got a risk assessment tool, and once we understand the levels of risks for different disease states, we’re building that knowledge into the clinical decision support, whether through order sets or care plans, or nursing documentation, or to-do lists—really trying to nail things down that cause readmissions. A big part of it is medications, making sure the patients understand their medications; and obviously, making sure they have follow-up visits after their discharge.

Meanwhile, on the outpatient clinic side, what we find is that poorly managed diabetics get readmitted, while well-managed ones do well. But about 20 to 30 percent of them inadvertently don’t have diabetes on their problem list. Their physician has been treating for diabetes for many years, but somehow hasn’t put diabetes into their problem list, so the items on the checklist aren’t being managed aggressively; they’re not being treated as aggressively. They tend to fall through the cracks more often, and so just making sure we’re managing our diabetics effectively is a big first step.

HCI: Coming from an organization that is very far ahead in leveraging analytics to improve care quality and support clinicians, Dr. Longhurst, where do you think CMIOs and their teams are right now in that important area?

Longhurst: The challenge with analytics is that it really needs to follow a thoughtful, well-executed EHR implementation, right? Everything out in the field is further behind in clinical analytics than it is in EHR implementation, by definition, but hopefully, it’s developing in parallel with the EHR. You take a place like UPMC, where they’re far beyond their initial implementations, they’re farther ahead on analytics as well; I think you can pretty much guess where an organization will be on analytics, based on where they are on EHR right now.

INTEROPERABILITY AND HEALTH INFORMATION EXCHANGE

HCI: Dr. Banas, as you and your colleagues at VCU work your way forward with creating and improving interoperability and health information exchange [HIE], what are you finding to be the most challenging elements in those areas?

Banas: To me, the government is doing a pretty decent job in setting standards and specifying norms on this, but for us, it’s very expensive and difficult to jump into a health information exchange; and because there aren’t a lot of other players out there for us to connect with, I’m not sure that we’re getting our bang for the buck. We’re essentially being asked to leap out there and do this. In a world of restricted budgets, what happens is that when only 60 doctors are on our physician portal right now, for the c-suite, that doesn’t exactly resonate yet. This would be a way for VCU to differentiate ourselves: we could say, look at us, if you come to us as a patient, we’ll have your record and information everywhere to send to people; but it’s hard to convince the c-suite of this.

HCI: That’s part of the challenge, convincing them, correct?

Banas: Indeed. Strategically, it seems like a no-brainer and the right thing to do, but operationally, it might be a luxury we can’t afford at the moment.

HCI: Dr. Velasco, would you also agree that the exchange of data is a strategic imperative?

Velasco: Yes, I would gather that under the headings of meaningful use and population health as a key strategic imperative. Real, meaningful health information exchange, and quality measurement, are both very central to Stage 2 meaningful use.

HCI: When it comes to working to develop more advanced versions of clinical decision support, where do you perceive CMIOs and their organizations to be right now in their progress?