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: Ferdie (Velasco), you’re a physician, isn’t there a big reluctance to take action off a test if you didn’t do it yourself, if it wasn’t ordered in your practice or at the hospital? Don’t you set yourself up for liability issues if you take clinical action off a test that turns out to be wrong?
VELASCO: It’s certainly true that there is a reluctance to accept information that’s not from a trusted source. On one level, we will eventually need to get over that because retesting contributes significantly to unfettered healthcare costs. But you’re right, there definitely is a discomfort with that.
Getting back to your question of why our information exchange is primarily one way at this point; truthfully the physicians in the community aren’t that interested in sending their data to the hospital at this point, partly because they don’t want the data to get into Texas Health Resources’ (THR’s) hands. Their interest right now is getting their hands on the hospital information. So if the hospital has a pathology report or an operative report and things like that, these things were historically faxed to them or mailed out to them; they’d like to be able to acquire these things electronically and import them into their physician office EMR. That’s where 90 percent of the interest is right now in interoperability and health information exchange. They’re not really that interested right now in being able to upload data from their ambulatory environment into the inpatient hospital EMR.
GUERRA: They may not be, but I would imagine you are, especially in the emergency department. You have patients showing up there, you would really like to see all the data that had been gathered from all their providers in the community so that treatment could be as accurate as possible, based on as much information as possible. So they may not be interested, but I’m sure you are. Does that make sense?
VELASCO: Oh yes, we definitely are. I think the workflows for that kind of interoperability need to be figured out. I think the problem is that people could jump immediately to the long-term vision of semantic interoperability where somebody’s documentation of the patient’s medication list and allergies, and all that stuff, just magically populates the corresponding data fields in our Epic environment. That’s not only not realistic today, it’s not even necessarily desirable given the data integrity concern that Ed shared earlier. What I think would be helpful today, and perhaps for the next few years, is it needs to be in a read-only fashion. That way, people can access and view that data so you don’t have to take a comprehensive history again when that patient shows up in the emergency room setting.
GUERRA: It seems privacy and security issues are sinking a lot of HIE-type projects. What are your thoughts?
VELASCO: Well, I think it’s tricky – trying to find the balance, and I’m just going to echo what John Glaser said recently, he was one of our keynote speakers at the Scottsdale Institute teleconference here that we hosted at THR. There are legitimate arguments from both sides. The folks that have concerns about privacy and the potential misuse of the data represent issues that need to be addressed.
And then there is the other side of the coin, which is if we’re so restricted as to how the data is shared and made accessible, that it’s basically locked up and no one has access, then it can’t be used for secondary things like research and comparative effectiveness.
So it’s going to be an ongoing dialogue between both sides, if you will, and require constant recalibration to find the balance. As John Glaser said, if patients concerns about privacy are not adequately addressed, basically they’re not going to contribute. They’re not going to give you a complete history, a useful history, and so having that data available in the EHR is not going to be useful either. So again, it’s just a balancing act.
GUERRA: Tell me about your work with some of the largest IPAs in the area. How many physicians are in these big IPAs, and how do they want to be approached? What do they want from the health system, and what don’t they want?