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

So we’ve been meeting now since March on a monthly basis, and the meaningful use subcommittee started about three months ago. I’m not saying this is the best practice, but this is one that seems to be working very well for us and, because of this, not only are we on target to collect all of our funds regarding meaningful use, which for an organization of our size is fairly substantial, but we’ve also increased our capacity to apply for grants.

So even though we do have a good research organization, and certainly they’ve been applying for grants and winning grants, with this additional emphasis and this committee, we’ve been applying for more grants than we would have in the past.

So far, we haven’t received any, but that’s partially because the government has been fairly slow in doling those out.

GUERRA: When you talk about health information exchange, are you specifically thinking of an HIE that would communicate with outside hospitals or are you talking about integrating with independent practices?

MARX: It’s both. To answer your question specifically, I’m taking about an HIE, not just for independent docs or our affiliated docs but other hospitals in the area and other ancillaries in the area. Of course, exchange is one of the five main areas for meaningful use, and so that has spawned a capital project for 2010, and we were able to leverage the stimulus situation in order to get funding for our HIE. We’re pursuing it on multiple levels.

GUERRA: Have you done much under Stark? Do you plan on underwriting, or have you underwritten, EHRs for the independent practices?

MARX: To Texas Health’s credit, once the Stark laws were relaxed about three years ago, we already had started a program where we were subsidizing physicians under the Stark provisions to adopt EHRs. So we’ve been doing that for a good two years. So we included the physicians in the selection process. They ended up selecting three. We added a fourth, which was Epic because we use Epic in-house, and so as long as they adopt one of those four, they have varying degrees at which we subsidize them.

GUERRA: What are the other three?

MARX: The three that they’ve selected were eClinicalWorks, Allscripts, and NextGen.

GUERRA: So you give them four options.

MARX: They get a higher subsidy if they choose Epic, because obviously it’s advantageous to have the whole ecosystem on Epic.

GUERRA: Four seems to me like a lot of integration work. I’ve heard one, I’ve heard two, occasionally three, but four seems like a lot to handle.

VELASCO: The insight I would share is that Texas Health tends to historically have been – eclectic may not be the right word – but open to multiple options, particularly when it comes to physicians. In fact, our CEO, Doug Hawthorne, uses the phrase, “a house with many rooms,” to describe our physician group, which suggests a lot of flexibility, a lot of options for how physicians may choose to participate in this physician group.

Some are opting for a fully employed model, where they basically turn over to the health system all aspects of the practice, where basically all of your salary comes from the health system. Now, that may not be appealing for a lot of physicians in the community, but many are still interested in some form of integration. So one of the things that we are looking at, as I’ve mentioned, is this concept of an MSO-type service where they will still remain independent, but increasingly some back office capability will be provided by the health system.

To make that attractive, our senior leaders felt we couldn’t really afford to just have Epic, which is what we’re rolling out in our inpatient environment, our ambulatory hospital-based clinics and in our own practices. They felt it would be necessary to have some options.

Some of our physicians are very independent, particularly here in Texas. So the concern was that they would not buy into a program where all the data would essentially be owned by Texas Health Resources, but that would be the case if they signed up for the Epic platform, because it would be our instruments in Epic and wouldn’t be a separate database.

It was felt that only offering that option would not be attractive enough. So since eClinicalWorks and Allscripts were the two predominant office-based EMRs in use by the independent private practice physicians, we thought making that offering available would be attractive alternatives to the Epic-only solution.

GUERRA: Ed, I would imagine if you had your way, from an IT perspective, they’d all be on Epic.

MARX: Yes, one of our principles, since that time, has been simplification. We’re undergoing a project right now called “Application Rationalization,” because we grew through M&A activity and allowed a lot of different choices. So now we have 450 different applications, which is expensive to maintain. So our focus now is actually to reduce the amount of apps. I wouldn’t personally have offered four, but to Ferdie’s point, if you want to work closely with your medical staff and your customers, you definitely have to listen to their opinion. So the answer is probably somewhere between one and four.

VELASCO: That would be the other thing I would add, there are some local IPAs that are doing the same thing, that are trying to offer these physician offices EMRs at a discount. So they were also looking at the same three that Ed mentioned, so we felt obliged to keep up with them to be competitive.