Earlier this year at the Dallas-based Methodist Health System, Pamela McNutt, senior vice president and CIO, and her team, completed a systemwide launch of its new Epic electronic health record (EHR). The go-live ran simultaneously at all of the patient care organization’s 46 facilities, with the goal to create an “integrated patient record,” McNutt says. In a recent interview with Healthcare Informatics, McNutt, a veteran CIO with 30 years of experience in health IT, discusses the motivation behind that go-live, how CIOs can help reduce physician burnout, and what innovation she’s seeing these days in the Dallas region. Below are excerpts of that discussion.
(Editor’s Note: Looking for more? You can collaborate and share best practices at the Dallas Health IT Summit in December).
What core health IT initiatives are you working on these days?
We just completed a big-bang implementation of Epic across our hospitals, teaching clinics, specialty clinics, and community and family practice clinics. We went live for all modules on April 1. The biggest reason for [moving to Epic] was that for our own health system and where we were growing, we really felt like we needed an integrated record. That was number one. Also, so many other people in the Dallas-Fort Worth region had Epic already, so physicians had experience using it.
When one EHR vendor dominates a market, is that a good thing for the healthcare landscape?
I do see it as a benefit when everyone is on the same system. While the idea is for our providers to be on an integrated record, it’s actually most important for our patients to be on one patient portal as well. Across the region, to be on one platform means that your patients and physicians are both familiar with the portal and the system. Patients in this region go from one health system to another, so it makes it easier for providers in that sense, too.
What is the state of evolution of health information exchange (HIE) in the Dallas-Fort Worth region?
Well, [most people] probably know that the HIE in this region “stood up” back when there were incentives, as it was not sustainable. So we are not connected right now to any of the Texas HIEs. We were an early connector in the one that started in the Dallas-Fort Worth region, but just two organizations actually ever joined it before it became unviable. The whole [process] is very expensive. However, in this market, because almost all of us are on Epic, and also because of direct messaging, and now EpicCare Link (Epic’s web-based service that provides access to patient EHR data), we are exchanging thousands of records every day. This exchange is happening with non-Epic providers, too.
Physician burnout has been a hot topic of late. As a CIO, how can you help reduce the stress that IT can put on doctors?
Well, back to the reason we went to Epic, we went with its foundation system, which is said to be a compilation of what the best practices are across the country. So we thought by doing that we would be giving our physicians the best experience we can give them. As far as general burden and burnout with physicians, I don’t care which EHR it is, I think physicians are frustrated by the amount of documentation they have to do. And this more to do with the government and government programs that are requiring documentation; it’s not [as much] a vendor issue. So these requirements are burdensome on providers, and we do whatever we can to ease that burden, whether it’s a tap-and-go-single sign-on with a badge, or using best practices templates.
Also, MACRA (the Medicare Access and CHIP Reauthorization Act), and the Inpatient Prospective Payment Systems (IPPS) program do directly relate to your EHRs, and frankly those are some of the sources of the documentation burdens that are currently going on. To keep up with those various reporting mechanisms, you do need your IT systems upgraded to certain levels and to keep them up to speed to be able to support those endeavors.
As a CIO, how closely do you work with your CISO on ways to continuously improve your cybersecurity strategies? Has this become more of a priority of late?
We have always had a high posture on data security, and we constantly keep in communication with our peers. Our CISO specifically keeps in communication with them, and they discuss best practices, give each other heads ups and warnings on things, and that’s when you might discover that maybe there’s a tool set that might help with particular things. I think we have become more engaged, and we are testing more with each other. So you can ask yourself, are we really as best practice as we think we are? Are you doing all you can do about intrusion protection or patching? And you can then test the waters on that. I think there has been much more dialogue around security. That doesn’t necessarily mean that we’re buying a ton of products for it, however.
What are some of the most innovative health IT endeavors that you’re seeing take place in this region?
We’re hearing and seeing a lot of people go down telehealth roads right now. We are doing that and colleagues are doing that, too. We are, however, just starting with telehealth, and it’s basic. Many people have a pocket of telehealth, such as tele-neurology in your ED, and what we are doing here is urgent care-type telehealth. In Texas, some of the rules have been relaxed about telehealth and people have moved further along with it.
You also have to react to MACRA, with value-based care [eventually] taking the place of traditional [fee-for-service] models. One thing I have noticed in this region is that a few years ago there was a push to buy population health-specific products, but what happened was that the population health initiatives didn’t grow like we thought they would in Dallas-Fort Worth. The payers just didn’t came to the table.
A lot of us were doing the Medicare Shared Savings [ACO program], and other health systems here in town did get some traction with some payers, but pundits were saying that by this time, the payment model was going to totally shift and that population health would primarily be the way we would get paid, but that just hasn’t happened here in Texas.
What was the reason for this?
I’m not too sure on what the motivation was on part of the payers. These models are about risk sharing, so did they think was it too much risk or did they not want to share the upside? It’s hard to say for sure, and they might say that it’s because employers they were selling to were not pressuring them. But either way, it didn’t come in the groundswell in which we thought. If you asked me this a few years ago, the answer would have been about installing systems, and practicing and preparing for our Medicare Shared Savings [ACO] programs so that this big shift to population health would happen. But that has not been the case.
What is the biggest challenge that’s preventing more health IT advancements in this region?
I think what it has to be about is access to healthcare and access to data for patients. Also, I would like to see more interoperability occurring, but there are simply some harsh realities across the country as to why it’s not taking off. One reason why is the business incentive around it, so who wants to have this interoperability badly enough to pay a lot of money for it? I think people would [pay for it] if we found a way to penetrate deeply into the doctors’ offices. Interoperability seems to start with hospitals, but you have so many community doctors that it just has not been feasible, either technically or financially, to connect them up. So it’s a chicken or the egg situation. When do you get the critical mass so that it’s actually valuable where people want to pay a lot of money to have it?
And getting back to the patients, if they can control the data and serve as the health information exchange by forwarding their data to the doctor they are about to see, could that be a different way we can go about this? When people think of interoperability, they think of clinical data literally flowing straight in one from record to another, but it doesn’t work like that. You don’t just take in clinical data from an outside source and automatically load it into your EHR. It always requires a clinician to look at that data and see if it’s accurate, and see if it should be integrated into the record. So there’s still a manual piece to this. I think we’re still a ways away.