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Louisville, Ky.-based Norton Healthcare is composed of five acute care hospitals: Kosair Children's Hospital (263 licensed beds); Audubon Hospital (480 licensed beds); Norton Hospital & Norton Healthcare Pavilion (719 licensed beds); Norton Suburban Hospital (380 licensed beds); and Norton Brownsboro Hospital (a brand-new 127-bed facility). Additionally, Norton Healthcare provides service through 10 immediate care centers in the Louisville area. Recently HCI Editor-in-Chief Anthony Guerra had a chance to talk with VP and CIO Joseph DeVenuto about how he’s handling HITECH, among other challenges, at his sizeable health system.
GUERRA: What are your thoughts on the future of acute/ambulatory data exchange?
DEVENUTO: Well, if you read some of the text around meaningful use, some level of information exchange will probably have to occur in order for us to be meaningful users of the application. So I understand physicians would want to see what had happened to their patients while in the hospital, but I don’t see that being at a detailed field-by-field level. I can see the hospital sending an electronic discharge summary type of report to that physician’s office, which gets embedded into the ambulatory record.
GUERRA: So you are not thinking of discrete data, but rather a PDF-type document.
DEVENUTO: An electronic document, yes. There will be some areas, like lab data potentially, that may be discrete at some point, but I think the consensus around what’s a common document to share from a hospital to a physician practice will probably be some level of electronic Word document or PDF or something like that.
GUERRA: I’ve heard people say that what you are describing is possible, whereas exchanging discrete data industry-wide is a bridge too far at this point.
DEVENUTO: Whether that’s the case depends on whether or not everyone can agree on interfaces, terminology and nomenclature. Right now, there is still too much data that’s not standardized, and labels and naming that aren’t standardized. So that’s where it gets really messy. From a practice-based perspective, we have to be careful about sending huge amounts of data to the practice system, because then their requirements around storage and backup and recovery, and all those things, are exponentially greater, especially if we start talking about PACS images.
GUERRA: What are your thoughts on how the meaningful use discussion has moved along?
DEVENUTO: First off, I would say that what they’re trying to do is worthwhile to improve the healthcare of the United States. But the practical implications of that become significantly polluted. There is a lot of the literature out there right now that questions whether there really is a return on investment for clinical systems in hospitals. The interesting thing is that if everybody qualifies for meaningful use on day one, there’s not enough money in the budget to actually pay everybody.
And it’s a ‘unique opportunity’ that I have to pay for it all before I start getting reimbursed for it. From a Norton perspective, on the hospital side, I am relatively confident that we’re close or fairly close to at least the preliminary recommendation of what meaningful use is. I still have some gaps to address, but I’m closer than most, or some. But it becomes difficult because I don’t think the HIS companies can handle the volume they are going to see. It’s almost as if, if you want to get help, you’ve got to sign up now to get in the pipeline, or else you won’t be in the pipeline at all.
GUERRA: But you don’t even know what you need to sign up for yet.
DEVENUTO: Right. Well, it’s definitely stimulating the consultant space. I mean, without a doubt.
GUERRA: What if I were to say that 90 percent of the people involved with crafting policy on this weren’t concerned with your margins or profitability as an institution. Would that sound right?
DEVENUTO: I would probably agree with your sentiment. I think at least on the surface, this appears to be an excellent academic exercise. And, actually, I agree with what they are trying to do. I think there is value in sharing information to improve overall health. But do I think this is going to solve the healthcare delivery budget problem? I don’t know that it is. I mean, would we have been better served to solve the uninsured problem first by providing some level of universal coverage, because that pulls out a ton of cost from the ED, which often functions as the family practice for the uninsured. If we could potentially work on reimbursement to pay for proactive care versus reactive care, that would have driven a lot of cost out of the system. But just pushing out, propagating what we’re currently doing, I don’t know that fixes anything.
GUERRA: Do you think this legislation is well suited to rolling out technology like CPOE and EHR software?
DEVENUTO: It’s hard to say because while they made the recommendations around it, they haven’t actually talked about how you measure it. If I have it turned on, does that mean that I’m using it? If I turn it on, is it 50 percent of my doctors doing CPOE 50 percent of the time, and then how do I measure that? (after this interview, a preliminary definition stipulated 10 percent of all orders must be entered electronically by 2011) I think there’ll be a lot of entertaining dialogue between now and whenever.
GUERRA: Have you figured out how much you stand to receive under HITECH?
DEVENUTO: Yes. Our reimbursement department did some number crunching around that. On the hospital side, I think they were still thinking $6-8 million because it’s based on Medicare population and Medicaid population, etc, and probably $6-8 million on our employee physician practice side.