In October, Larry Stofko took the IT helm at St. Joseph Health System. Stofko — promoted into the senior vice president and CIO job at the 14-hospital $3.7 billion not-for-profit Catholic health system — had been with the organization for seven years. Most recently, he served as vice president, IT strategy and innovation. So what’s it like to go from a supporting role to a true leadership position? Recently, HCI Editor-in-Chief Anthony Guerra chatted with Stofko about his new role, and what it takes to be a successful CIO in today’s environment.
AG: Tell me more about your goals for the Azyxxi product.
LS: Two out of three of our big organizational goals can be helped by Azyxxi. One is perfect care, and that really focuses on all of the evidence-based medicine, the healthcare equivalent of zero defects, trying to make sure that we use not only external evidence but also internal best practices. That involves trying to drive wrong site surgeries to zero versus saying let’s have a 10 percent decrease this year and 10 percent decrease next year. I’ll mention how I think we can support that in just a minute, but I’ll mention the second goal so you have both of them in your mind.
The second one is ‘Healthiest Communities.’ That means that — in the markets we serve — we will have the healthiest communities in the nation. So we’re looking at what can we do as a health system to create that outside the four walls of the hospital.
And I’ll mention the third one just so you know what it is. It’s called ‘Sacred Encounters.’ And that’s really how all of our employees interact with the patients, with coworkers, with vendors. They are instructed to really take the time and attention to be present and focused in what they’re doing. That may be a nurse, when she’s washing her hands before she gets into her patient’s room. For her to dismiss all the other thoughts that may be going on and to focus on the care of that patient when she’s in the presence of that patient. It’s similar to how I’m taking the time to focus on our conversation right now, to clear my agenda and shut the door.
AG: And not check your e-mails while we’re talking and lose your train of thought. I’ve had that happen a few times.
LS: Right (laughing). I think ultimately the repository will help and our systems will help because it will put the data where providers need it. This way, they don’t have to spend a lot of time scrambling for data. So in the long term, I think, a lot of the IT will support that goal.
But to get back to Azyxxi and the data warehouse, I look at its benefits and uses from three vantage points. One is real time access to information. So if we start taking all this information from disparate systems — hospital based systems as well as from physician offices — and pull this data together, an example is in the ED, and this is where MedStar (who developed the Azyxxi product before Microsoft picked it up) used it. That’s kind of how they used it, real-time transactional access to a large variety of data that you can get in a more rich fashion than in any one individual transactional system. Because each system by itself can’t give you the full picture of what’s going on with that patient. So that’s something we see using it for pretty quickly, because we’re going to push some lab results, ADTs, pharmacy information. We have a Web portal, but this will start to take in some additional hospital-based information from multiple systems and put that together for clinicians to make better decisions before they go into CPOE, as an example. So instead of just going in saying, ‘Here’s the order set I want to do within CPOE,’ having broader information that includes hospital-based and non-hospital-based, giving them a better picture in decision support. So that’s the transactional aspect.
The second one is around clinical decision support capability. This won’t happen day one but, as you can imagine — with 14 hospitals and 3,500 beds — as we start to amass this large amount information, we’d like to use the system as a clinical decision support tool. So if someone comes in presenting with shortness of breath or certain characteristics, we can say for the last 100 patients that were male that came in presenting these symptoms or chief complaints, how was it treated? What was the diagnosis or syndrome, and what was the cost and outcome of that treatment that we provided? So once you start to really amass a good amount of information, you can leverage your own experiences and not just wait for the evidence-based information that typically takes five to seven years to make it through Zynx and those products into distilled evidence. We will be able to really use our experience as a 3,500 bed health system across Texas and New Mexico and California. So I think that’s the second use, or layer.
The third really backs out more into the larger research. So once we start to amass the data, how can we tie it with the information from the Premier database? How can we integrate with our cost accounting and our other financial decision support, our patient satisfaction? And how can we research and correlate satisfaction levels based on the types of treatments, and even to start to incorporate the patient self-reported information, their functional status or things from personal health records.
So those are three large use cases and how they would support perfect care by having access to better, more complete information, as well as learning the statistics of what care is most effective. So that supports perfect care. And then the Healthiest Communities are supported by incorporating physician office-based information into Azyxxi if they have an electronic medical record. We have Allscripts deployed at 17 offices in Orange County, as an example, for 150 physicians. So let’s pull core elements of that data set and put it in Azyxxi as well. Let’s get the Qwest reference lab information — so that it’s just not all hospital-based information — and have that sit right next to the hospital-based information. That way, we can start to find trends of cholesterol levels or diabetes, things that are affecting our broader community for patients that may not have ever been in the hospitals. So that’s where we really help affect our Healthiest Communities goals.
AG: Are the office that have Allscripts clinics or group practices?
LS: They are medical office groups. They range in size from three to five physicians, up to 30 physicians.
AG: And those are not independent? Those are part of the health system?
LS: Yes. We would just start with them, but we would continue to go to the other IPA, independent physicians as well, which will lead to our physician EHR strategy taking advantage of the Stark relaxations. That’s another priority — health information exchange.
AG: So you are going to underwrite those costs?
LS: Yes, that’s the exact process that we’re defining right now, but we haven’t determined a definitive amount. We have defined our physician IT strategy for the office-based physician in four areas. One is offering them the Azxxi product. That’s one of four tools that we think will help the office-based, community-based physicians. That gives them a little broader picture and access to more information. The other thing we’re creating for them is taking our Web portal — branded as Physician Connect — and added clinical content to it, as well as some collaboration tools. We’re upgrading that portal to ensure single sign-on for any hospital based application and to Azyxxi. So that will be a value-added piece there. So that’s the second of the four pieces. And then the third and fourth are, one, for the physicians that already have an electronic medical record, we will, to the number that we decide upon, subsidize the health information exchange with the passing of hospital-based ADTs, lab results and transcribed reports so that can be integrated in their workflow. And then the fourth piece is that we’re looking at offering — either through building it or through partnering — a private-labeled ASP offering, an ambulatory electronic medical record, our electronic health record for our physicians.
AG: Do you think that will be Allscripts?
LS: I think we’ve had a great experience with Allscripts, we’re had a great relationship and we have the interfaces built. I think it’s natural that we would look there first, but we are bringing our physicians into the process to help solidify which one we would go out of the gate with. I’m not sure we would ever get to exclusively one, but it would be nice.
AG: Do you envision working with the physicians and the IPAs and coming to a consensus on one ambulatory EMR product? Or do you anticipate on giving them some choice?
LS: I think our goal and our initial objective would be to see if we can do it with one, because I wouldn’t want to say, ‘Okay, we’re going to offer one, two, or three and, by the way, we’re going to do those all at the same time. If we did that, we’d have to be in parallel writing interfaces to multiple systems and having to train people and implement and have multiple contract negotiations going on. So I think our goal would be to get consensus on which one is the out-of-the-gate provider. And then that way, if we get down the road and say, ‘Well, this one works just fine,’ then we don’t have to add another one to the suite. Alternatively, if we find that we really do need the flexibility to have two or three options, we can do that. But I think our goal is to gain consensus with some level of representation from across the health system.
AG: I’ve heard from another CIO who said that even integrating two EHRs can be a nightmare.
LS: That’s right because then you have opened up as the complexity of moving information between the two EHRs. Not just from the hospitals to two different EHRs, but you have to almost complete the triangle then at that point. As opposed to if you got one solution, then it’s more of granting access for the physician to look at that patient.
AG: There are different models for working with the Stark relaxations. Some health systems are mandating physician adoption, some are encouraging. Some are working incentives into managed care contracts for EMR use.
LS: Yes, and pay for performances is going to have its own set of incentives for why physicians would want to do this on their dime or on a larger portion of their dime.
A: With 14 hospitals and eight teams managing those hospitals, what is the procedure for large software buys? For example, if I’m the head of radiology in one of the hospitals and I want a new PACS system, or I’m in finance and I want a new revenue cycle management application, how are those requests handled? How do you get control of 14 hospitals with countless departments where everybody’s got their own specialty, their own point of view, their own needs?