With T&E trimmed, just as it is in all organizations, HCI editors rarely get a chance to interview sources in person. But when our source turns out to be a fellow New Yorker, it’s time to take a cab across town for some real one-on-one time. I was lucky enough to do this recently, and have one of my best interviews of the year as a result, when I linked up with NYU Medical Center CIO Paul Conocenti. The result? An engaging look at a major medical center overhauling its IT environment to completely integrate the continuum of care. — Anthony Guerra
GUERRA: When HITECH and meaningful use take their final form, some organizations may see they are on track, while others may find they have been taking their organization in the wrong direction. How do you see that playing out?
CONOCENTI: I think it’s going to play out for the best, but it’s also true there are going to be a lot of unhappy people. As you know, meaningful use has three basic components to it (A) you’ve got to be certified, and right now there is only one inpatient certified product, which happens to be Epic (EpicCare Inpatient Clinical System. On June 18, Opus Healthcare Solutions’ OpusClinicalSuite 2.3 became the second inpatient EHR with 2008 CCHIT certification).
And then the other part (B) is the interoperability thing, which I think is at the center of a big problem, and then the third (C) is reporting quality measures. So, those are the three things that go up into meaningful use, and embedded in the quality stuff is a lot of the decision support rules and things like that.
So, I think what’s going to happen is people out there under HITECH are going out, getting EMRs, not knowing the implications, not knowing that they may be purchasing something which won’t qualify them for meaningful use, and not get their $44,000. There’s a whole lot of marketing out there. I mean, I get pitched by five vendors a day — some reputable, some just came out of the woodwork, and they’re all making claims to the physicians about what their products can do. So the concern is there’s going to be a lot of people who have bought systems under the idea that they’re going to get this $44,000, and then all of a sudden the ruling of what meaningful use is is going to come out and there’s going to be a whole backlash around that. I think that will happen and then they’re going to have to back off of what meaningful use is going to be, because the grand national czars, after you do this for a period of time, you become immune to reality sometimes, and the reality is that if they say interoperability means that you have to exchange codified data, and you have to map X to Y and come up with Z, because Z is now the standard, magically, and unless you do that, you don’t qualify for meaningful use, you’re going to get a riot.
What they might be able to do is, instead, is just require the sharing of a document, the CCD, and we don’t need to actually import it as codified data. If they say that, I think there’ll also be a backlash, but it’ll be a more manageable backlash, because I believe that as long as we are able to say that the initial requirement is around sharing a document, they can up the ante in later years.
Because at NYU we have a large voluntary community, the demand for us to help our voluntary physicians is huge right now, and we have just redone our plans for our ambulatory rollout to meet the acceleration for 2011, which initially we planned as a normal rollout over three to four years, But these physicians want to get the stimulus, they’re signing up, they want us to help them, and so we’ve accelerated that. What about the physicians that are not affiliated with anybody? Who can really help guide them? NYU can help its physicians and other large organizations can help their physicians, but if you think you’re going to do that alone, you’ve got be really careful because there’s a lot of hype out there, and that’s how I think it’s going to play out.
The other interesting thing will be to eventually see if all this has really made a difference — we did it, we’ve implemented EMRs, who’s them going to be measuring whether or not the objectives have been met, and errors have been reduced and cost has been reduced and quality has improved and all that? Health information technology is not going to improve health. It's going to enable the clinicians who are caring for patients to improve health, but it’s not going to do it on its own. We all know you can implement the best technology and screw it up. The easiest thing to do is screw up a great system if you’re not careful, and the organization must have bought into the plan and understand its responsibility in an IT transformation for it to work.
And so the thing that encourages me is that at NYU, this is not an IT project, this a medical center project being driven by the senior leaders of this place, and I’m just providing service to that. And that’s a huge difference that I don’t know is happening all over the place.
GUERRA: What if it’s determined, five years from now, that we’ve reduced medical errors by 20 percent, but somebody can also prove that we’ve reduced hospital revenues and physician income by 20 percent? Would that formula be sustainable?