Not to be outdone by his neighbors at Partners HealthCare, John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, is hard at work integrating his acute facility with associated physician practices. The undertaking is a massive one requiring the build out of infrastructure and plans for ongoing support. Recently, Halamka chatted with HCI Editor-in-Chief Anthony Guerra about his plans to electronically ink the acute and ambulatory worlds.
AG: Are you running this completely or working with a partner on the IPA side?
JH: No, I’m running the whole thing.
AG: Does the fact that you are well known as a thought leader make it easier to get people to follow you?
JH: I’ve been CIO at Beth Israel for about 10 years, and everyone has their ups and downs (chuckle), but since I’m a physician and I have a decade of helping people, they have given me a lot of latitude in really overseeing the implementation of the project.
AG: It sounds like in Massachusetts you have a lot of support with different organizations. Is that the case? Do you think other states may not have that level of support?
JH: It’s amazing how Massachusetts uses IT not as a strategic differentiator for any one organization, but something that lifts the bar for the whole community. So I have no problem with going to John Glaser (Partners HealthCare CIO) and saying, ‘Hey John. How did you solve this problem?’ Everyone works for everyone else’s benefit, and that’s why we’re at 50 percent penetration of electronic health records in our state, compared to 18 percent across the country. We’re all non-profits, we’re all regionally focused, and we work really well together.
AG: What is the most exciting part of this for you? Is it pulling off the IT part, the project management or the potential for improving care?
JH: If you look at the drivers for all this, as a physician, the first thing I care about is clinical integration that improves the quality of care. Because you’re coordinating here, suddenly it isn’t just, ‘So Mrs. Smith, what meds are you on?’
Second, is the idea that you can actually achieve economies of scale. Instead of $40,000 to $60,000 per doc, which is what you typically see as implementation per EHR in this country, we’re going to get it down to $25,000. So if I can get it down to $25,000, suddenly that’s getting affordable, an alignment of incentives is possible, and you can get real adoption. And then of course the thing that is scary is that technology is only a small portion of an EHR rollout, it’s all the practice transformation, all of the organizational dynamics and change management too, and so being able to try and do that and do it with a lot of partners, and do it well, is very exciting.
AG: Who is actually going to help the docs with their workflow?
JH: A combination of internal staff — so I have hired experts who work for me directly — and the Mass E-Health Collaborative, leveraging both of their expertise will provide teams of practice-transformation experts.
AG: So you could see a doc calling a hotline and making an appointment for a transformation expert to come in and help them?
JH: That’s actually what we do. We are dropping our experts into doctor’s offices to look at their existing current state and ask what are the changes necessary to transform their practice from paper to electronic. Concordant goes in and does the same assessment and says ‘What do we need?’ in terms of printers, PCs, network. So between my staff and Concordant, we really do get that sense of ‘Well, how do we transform this practice?’ We hope to be like a Starbucks franchising model. When they open up a new site, it’s not like they haven’t done it before. We want to get to the point where a SWAT team drops into the practice and says, ‘We’re going to do this. Six weeks, start to finish.’
AG: Will eClinicalWorks have people on the ground?
JH: They do a lot of the additional set up of databases, and they do help with architectural issues. So they have been a very involved partner in all this too.
AG: Is there one point of integration or aspect of this that keeps you up at night?
JH: So here’s the challenge. It’s wonderful if you can get doctors to put structured data in for every field, but alas, you’ve got 12 minutes to see a patient, document it, etc. So what we’re doing is we’re saying, ‘What are those must-have data elements for quality and pay-for-performance reporting? So we’re building eClinicalWorks templates with a combination of structured and unstructured data. This way the doctor can get through quickly, but we’re still capturing those data elements that are yes/no answers. We can’t be doing free-text searches to look for the word ‘tobacco.’ Finding that balance between structured and unstructured data is very hard.
AG: What are the next steps here? I see you have a pilot phase this spring.
JH: We’ll get those pilots rolled out, make sure they are scalable, cost-effective, refine the application setup and the infrastructure design and begin rollout — a new practice every six weeks. Then we’ll just roll through them until we get them all done. It will be about three years, start to finish.
AG: And you hope to have 100 percent of physician practices on this system?
JH: That’s the goal.
AG: And the Partners model is that you’re out of the network if you’re not up and running by the end of 2008. Are you doing anything like that?
JH: At Beth Israel, our mandate is already in place that if you are an owned physician, you need to be on the EHR by July 1 or you will not be able to practice. I imagine we will come up with a similar mandate for the non-owned side once we prove that we can do it. Obviously we first need to show them a good path to get there, so it’s a little early right now.