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One-on-One With North Shore Long Island Jewish CIO John Bosco, Part III

December 8, 2009
by root
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In this part of our interview, Bosco says electronically integrating community physicians is one of the highest priorities a health system can have.

At the end of September, 13-hospital North Shore-LIJ Health System announced it was subsidizing up to 85 percent of the cost of implementing Allscripts ambulatory EHR in the offices of its more than 7,000 affiliated physicians in New York City and Long Island, constituting a $400 million investment. Specifically, the plan calls for North Shore-LIJ to provide physicians with individual subsidies of up to $40,000 over five years. To learn more about the project, HCI Editor-in-Chief Anthony Guerra recently talked with CIO John Bosco about the strategy behind this massive tactical move. (Read a related interview with Allscripts CEO Glen Tullman)

(Part I, Part II)

GUERRA: In terms of your deal, where will the practices get the change management advice, the information about implementation best practices? Will they get that from AllScripts?


BOSCO: I think, for the most part, they’re getting that from Allscripts. I think we’re going to have some level of involvement. I mean, Allscripts is contractually going to do the installation. The package that we worked out with Allscripts contains onsite training at the office location and onsite activation presence. This is our name and reputation behind all of this, so we tried to do those things that we really thought were going to make it successful.

Contractually, Allscripts has a lot of responsibility, but we are behind the scenes working to make sure we’ve designed a successful program. We have our quality group at the health system, called the Institute for Clinical Excellence. We have a couple groups in that institute, one that we call the Evidence Based Medicine Group and another one that is focused on workflow. And so they’re behind the scenes working with us and Allscripts to say, “You know what, the system that we’re going to put out in all of these offices, we want to make sure that the Evidence Based Medicine Group is looking at clinical content and the care guides, the clinical practice primers, as we’re calling them,” so we’re going to be looking at these care guides and making sure that they make sense.

And then we also have a group that is looking at the basic setup of the system, and the work throughout the system, to make sure it’s adequate, and that it’s efficient, and that it’s one that we think will suffice for a large majority of the practices without having to tweak it. So we’re doing everything that we can. We’re not just saying, “Allscripts, go in there and do whatever the heck you want.” We’re trying to work together with them so this is successful.


GUERRA: What’s the current best practice for getting the old paper records into the EMR? Do the docs ask about that?


BOSCO: They always ask because that’s always high on their priority list, this overflowing chartroom that’s taking up so much space. Since there’s only so much we can cover in a demo, we’re not really giving them complete information about it because we only have them for a couple of hours. What we do tell them is that there are some best practices, that if they decide to sign up, that’s one of the first things Allscripts will do. Again, they come and they do an assessment or a readiness assessment and they do an implementation plan with the physician, and that precedes access to the software. So during that assessment and plan, they start looking at their current workflow, bringing best practices to them, talking about what to do with charts, talking about how to best setup the workflow – whether, for example, there are medical devices that you’re going to want to connect to this or to hold that off for a later phase – but we discuss all of these things and that includes what to do with the charts.

So I mean, I guess there’s best practices, but it’s individual to everyone because what a solo practitioner might do is going to be different than what a 75 physician practice does. It all comes down to, “Do I want to scan all the charts or only a portion of them? Am I going to scan the whole chart or just abstract certain data elements and attach those to the records?”

You have to decide how much of these charts you really need to get electronic and what’s the cost/benefit. Those are tough challenges, and I think that Allscripts, with this being their primary line of business, does have best practices and does have ideas to bring to these guys. And as I even said to them recently, this gets very expensive in terms of what to do with your charts. There are some things that we’re not allowed to subsidize, such as hardware and people and charts scanning and all that stuff, but we will certainly help them think through the best things to do.


GUERRA: I know Eclipsys is now your major inpatient system, and you have Allscripts in the ED and some practices. Just take me through your overall software environment.


BOSCO: Sure. We made a decision five years ago to use the Eclipsys Sunrise Clinical Manager as our EMR, and we are still on the process of rolling that out. We’ve got pieces of it up at five of our 13 hospitals, and that project has proceeded along really well. It has been very well-received by the physicians and other clinicians who are heavily involved. And then I have to make clear it’s not an IT project, it’s a major enterprise initiative. I mean, I really feel lucky that I’m in a place where everyone is bellying up to the bar to do this, and it’s not IT dragging everybody through it.