One-on-One With New Hanover Regional Medical Center SVP & CIO Avery Cloud, Part I

CLOUD: Well, I think there may be a loss of control, but not a loss of influence. Physicians recognize that it’s in their best interest to be in concert or coordinated with a hospital, especially physicians who admit frequently to our hospital. So, I do think we can exert some appropriate influence and provide some movement toward standards and integration, but yes, there is definitely loss of control. But, we believe that’s less important if we achieve an effective HIE, because really the idea of thinking that the whole world is going to move towards a single anything is a pipedream. So I really believe that the appropriate strategy is to put ourselves in the position where we can accept all comers, and an HIE strategy helps us do that.

If a doc rejects our two recommended systems which offer tight integration to us, we can at least get them connected through some type of regional communication strategy. So it’s a two-tier, if you will, a two-level connectivity approach that we’re employing. Actually, three-tier I would say, because our own clinic will be tightly integrated with the hospital EMR. All the surrounding physicians that accept our standards will be loosely integrated with our EMR through interfaces, and then docs that totally reject the two above will be connected through a health information exchange. So that’s the strategy we’re employing.

GUERRA: It sounds like your CPOE and physician documentation timeline is a bit further out than the meaningful use timeline being floated. Does that mean you’re going to have to move things up a bit, and is that disruptive to your overall plan?

CLOUD: It is putting pressure on our plan. We believe we will meet that timeline because, if I read the legislature appropriately, you have actually two years. So, if you make it by 2012, you could still get full stimulus reimbursement. So we’re hoping to make it by late 2011. We feel sure we’ll make it by 2012, which still puts us in a good position. But it has definitely put pressure on our plans.

GUERRA: Have you found the independent physicians receptive to doing CPOE/EMR? Do you have an overall plan for fostering physician adoption?

CLOUD: Yes. It’s interesting. We did an area survey and we were quite surprised at how many docs are interested. Something physicians have figured out is that this is coming whether they like it or not. It’s not just about getting the stimulus dollars; it’s about them trying to achieve some automation that they know is going to be important for the future. As docs are getting younger and they’re part of the circuit board generation, they already understand and comprehend the importance of automation and workflow in their practices.

We’re getting a mix, but I really believe that the majority of docs in our area have an interest in moving forward, which was a good and pleasant surprise for us. We did that, like I said, via survey; so this isn’t just a guess, but we sent out surveys through several counties and to docs that would be participating with the hospitals that work with us on the collaborative.

Now, the issue is -- and this is really quite interesting -- that we have a lot of rural physicians, and their level of technological sophistication is problematic. So you have a two-doc practice in rural North Carolina and they have a single PC at the receptionist’s desk. Clearly, that puts them in a challenging position, and what those types of docs are going to be looking for is help. And to the extent larger organizations or collaboratives can come together and assist these physicians, to that extent we will be successful with this movement toward national automation. But I think those are the targets that will be difficult.

We have some docs that have their own IT departments – those guys aren’t going to be a problem. The key there will be to achieve a level of integration, connectivity, and interoperability. But our real challenge – and that’s what we’re trying to pursue here with the 11-hospital collaborative -- is to reach out to those physicians that are less sophisticated, less equipped in the information management arena. I think we have a unique opportunity here. We work with a group of physicians that represent about a third of the docs in North Carolina, and their leadership is well onboard with what we’re trying to do.

GUERRA: For the non-IT-savvy physicians that you just mentioned, do you think a Web-based, remote-hosted set up would be most attractive?

CLOUD: No doubt. An ASP model is right on top of our list of methodologies. One of the things we’re struggling though is trying to determine whether the hospital, or a hospital, should host that or whether some spin-off organization that functions somewhat independently should host that. Because, as you could well imagine, there isn’t – how should I put it – some docs won’t feel as comfortable having the hospital manage their information as they would having a third party do it.

The collaborative that we’re a part of -- CCHA (Coastal Carolina Health Alliance) -- could be the hosting organization, if we so decide. But we’re still early in those decisions right now. We think it’s going to be a phased approach. We believe that, in the initial offering, it will be wise for area hospitals to offer something to get it going.

GUERRA: Whenever you get into something like that, you run smack against the issues of data ownership, privacy and security, as well as funding. So who’s going to pay for it? Have you run up against these things?