One-on-One With Texas Health CIO Ed Marx and CMIO Ferdinand Velasco, M.D., Part I

October 19, 2009
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Marx and Velasco say, if you think your local physicians are independent, try working in the Lone-Star State.




Ed Marx Ferdinand Velasco, M.D.







Texas Health Resources is a 3,700-bed 14 hospital system in the Dallas/Fort Worth Metroplex with more than 18,000 employees. With almost 100 percent of its practicing doctors working as independent community physicians, the organization needs to be nuanced in its push to get EHRs into their offices. Working on that project, in addition to every piece of inpatient IT, is CIO Ed Marx and CMIO Ferdinand Velasco, M.D., along with the 525 FTEs that make up the IT staff. An annual operating budget of over $100 million helps grease the wheels, but that only goes so far with physicians who take their independence very seriously. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with Mark and Velasco (who he linked up with on Twitter @anthony_guerra, @marxists, @ftvelasco) about their plans to connect the acute and ambulatory worlds.

GUERRA: Tell me about some of the things you’re doing around HITECH.

MARX: We’ve decided to take a very strategic approach to this, so it’s not an IT thing. I’m co-chair of our Stimulus Task Force; the other co-chair is our senior vice president for government affairs, so he’s our political advocacy leader, if you will. The task force reports to the board. That’s a very unique feature. We didn’t want to get stuck in the bureaucracy that can happen at a large organization, because we have a lot of committees and it can be hard to get things done. We felt that this would not operate well under the weight of a lot of bureaucracy. So we report to the board, and our membership has hospital presidents, finance people, clinical people, a good mix of individuals that you would normally think of in such an endeavor. That includes education because some of HITECH includes not just the meaningful use component, but also we are very interested in pursuing grants. So our research organization is prominent in our Stimulus Task Force, and we meet monthly. Ferdie (Velasco) may have shared with you that CNBC was here a month ago to do a feature that has yet to air. So it’s pretty well organized, well run and had good participation.

The next thing we have that came out of the Stimulus Task Force at the high level is a subcommittee focused on meaningful use. So this subcommittee is getting down into the details of meaningful use, and we’ve created a – actually Dr. V created – a matrix or readiness assessment, which basically includes everything that has been said and put out so far. We know it’s all subject to change, but it compares where we need to go with where we are.

There are five major areas for meaningful use, and so there’s a primary and secondary executive in charge of each one, and they are charged between meetings to do this gap analysis.

So it’s pretty well organized. We know that the gap will be very small for us because we’re almost done with our electronic health record implementation. However, we also have HIE plans and personal health record plans, those sorts of things. So we don’t have very far to go fortunately, but we do have this committee so eventually the gap analysis will be done and we’ll have an action plan as to how we’re going to address the gap and when it would be filled. That gets reported back up to the Stimulus Task Force, which then reports that back up to our board.

GUERRA: I’m interested in the genesis of the Stimulus Task Force.

MARX: I think we do have a very well-organized approach to meaningful use, and the way that it came about is that we knew there were lots of dollars at stake, not even counting the grants. Again, everyone is so focused on meaningful use, but we’re looking at the whole package. There’s the meaningful use dollars, and then all the grant dollars available. So a few of us started talking, myself and this government affairs senior vice president that I mentioned, his name is David Tesmer. We wanted to make sure that our organization had this stimulus in its planning and realized what was at stake and that we were making moves towards it. We figured that it would be best to take a proactive approach.

So he and I got together; we had discussions about what could happen if we didn’t take a proactive approach. We could easily miss out on something, especially as we’re going into the 2010 budget cycle and contemplating the right projects for 2010 that would help us achieve meaningful use. For instance – health information exchange. So the idea of a task force started to make sense. We approached our bosses and decided it would be best to formulate this Stimulus Task Force so that we had a group that was charged, responsible, accountable, and transparent to go after this.

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