One-on-one With NYU Langone Medical Center CIO Paul Conocenti, Part I

PC: But there are some people still learning how to type, believe it or not, and we have a few of them, as I’m sure everyone does. It’s changing, but then you’ve got dictation, which is not really the codified part, but for that we use technologies such as like Dragon (Nuance), which does allow you to codify the data while using voice. It, in effect, is driving the mouse, as well as the voice recognition for the textural part of a note.

AG: What’s your percentage of employed physicians versus those with privileges from the community?

PC: It’s about 50/50, I mean, employees include the faculty group, part of our faculty group and practice, but our voluntary community is very large.

AG: I would imagine it’s much easier to get the employed physicians to accept some of the things you roll out. Is it a different process for bringing those two constituencies along with some of these projects?

PC: No. Within the walls of the hospital there is no difference between our voluntary physicians versus our employed physicians.

AG: The rollout is not more difficult with community docs?

PC: Not inside the hospital. If you go to the ambulatory side, it’s a whole different game. We have the ability within our faculty group practices and our clinics to roll out technologies, standardize order sets and it really comes down to the standardization, which is what we’re all trying to drive for. We’re trying to have a standardized platform for best practices built into the clinical system. How do you build consensus around what best practice is? We do it by specialty. Our approach is, when we are going and attacking a specialty, we’re indifferent to whether it’s a hospital employed or voluntary, we bring the specialists together to govern the order sets and/or the smart sets that we do on the ambulatory side, and build consensus around that specialty.

On the voluntary side, however, and we have to remember the operative word is “voluntary,” it depends on the extent to which they agree with what we’re promoting. In the hospital, such practices are required, established for how you take care of patients, so there’s not an issue with our voluntary physicians. As I said, it’s because we’ve been doing it for 30 years. We’re a teaching hospital, so there are residents there and there’s a lot of help.

AG: Over a year ago, I did a story about how Partners was mandating that any associated physician who wanted to practice at Partners had to get on one of two or three ambulatory EMR’s. Many people say, ‘That’s Partners, that’s Boston, you can do it up there, they have the critical mass.’ Could something like that work here?

PC: Well, it could work with your faculty group practice docs because they’re part of that organization, but when you roll out to the voluntaries, in New York City, where there’s 80 or 90 hospitals on the island, just about, and there’s a very competitive marketplace, that’ll be more difficult. But I think what they will respond to more is the stimulus, is the HITECH stuff, is the fact that they know now, they have to go on an EMR in order to survive.

Five years ago when Partners was doing it, it was really more of a push; Partners is pushing this EMR technology on these physicians. Today it’s a pull, the physicians are coming to us saying, ‘Hey guys, help us out, we want to be part of the revolution that’s going on with electronic records and the whole reform of the American health system.’ They are pushing us in the sense of asking for help. ‘Oh we hear about this Stark Law, so how much are you going to help us with that?’ So, we have actually rolled out now with our Epic program — that is our one program that’s integrating the entire clinical mission and integrating with the research mission of the medical center. We’re making a very bold move here, and we are integrating everything across one platform.

AG: You are getting rid of Eclipsys?

PC: We’ve got a two-phase implementation — our first phase is replacing and implementing the EMR across all of our hospital clinics, faculty group practice and our voluntary physicians. We are probably one of the only hospitals in the city that actually announced the program to our voluntary community under Stark that we are going to roll out Epic to them at a very, very discounted price. The price per doc is … let’s just say it’s better than Sam’s Club. So, we know that’s one benchmark, and we’re cheaper than Sam’s Club. We give them more than what they’re going to get with Sam’s Club because they’re getting the Epic system, they’re getting the practice management system as well as the EMR. That’s Phase 1.

Plus, in Phase 1, we’re redoing our whole revenue cycle component, and it’s not just billing that we’re talking about; it’s patient access, registration and scheduling across all of our hospital, inpatient and outpatient. Everyone is going to be on the same platform that our faculty group practice docs are on, that our voluntary docs are on, that our clinic is on. Unless you’re able to identify the patient securely and accurately, the aggregating data is not going to work because you’re still going to aggregate in silos, and then you’re going to have to connect the silos through some other record locating or matching algorithm, which is not perfect.