Charles “Chuck” Christian, vice president and CIO of St. Francis Hospital in Columbus, Ga., is chair-elect of the board of directors of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME). On January 1, 2015, he will succeed Randy McCleese and board chair. The St. Francis Hospital organization encompasses a 400-bed inpatient community hospital and an inpatient psychiatric hospital, about 20 physician practices, an ambulatory care center, and diagnostic imaging services. Christian had a 39-member team in IT. On the first day of the CHIME Fall Forum, being held at the J.W. Marriott Resort in San Antonio, Tex., Christian sat down with HCI Editor-in-Chief Mark Hagland to talk about his own organization’s journey around meaningful use and about meaningful use and other topics more broadly, from the perspective of CHIME leadership. Below are excerpts from that interview.
Where is your organization right now in terms of its meaningful use journey?
By the time I get back home from this conference, we will have attested to Stage 2 of meaningful use. It has been a nervous time for us, not related to the technology itself in any way, but rather, to the massive process change we’ve had to go through. We’ve had to make a lot of clinical workflow changes. Our workflows have worked very well, but were not designed to capture meaningful use elements. We’ve struggled with a few areas in particular. One has been the patient engagement piece, per the requirement that 5 percent of patients have to use our portal; so, making patients aware of the portal, and getting them to register for it and use it, has been challenging. The other objective that has been difficult has been the one requiring physicians to message with some patients; even requiring a small amount of messaging is difficult.
The thing we’ve struggled with is that that requirement basically puts the responsibility of our patients’ behavior once they’re outside our organization, on us. And though the incentive monies come almost at the end, the penalties are still there; and you could be disqualified for minor failures. So that’s really difficult. Of the other two elements we struggle with, one is around medication reconciliation. Even though from a patient safety standpoint we have an enterpriswe-wide set of processes, some of those processes had until recently been on paper, and we’ve had to work those out. The last one is the summary of care documents to be sent out to other providers. We have a good set of relationships with our local nursing homes, home healthcare agencies, and the like, but early on, we found very few of them had electronic accounts to exchange information through, so advances had to be made in those areas.
Beyond your own organization, what has been most difficult for CHIME member CIOs about meaningful use, the same basic issues that you’ve gone through?
I think so. Starting as of October 1 of this year, we’ve entered into a 365-day reporting period for Stage 2 in 2015; 90 days was tough enough. And with this, if you fail one day, you fail. The AMA [American Medical Association] has made recommendations to keep the program alive. With regard to the eligible physicians, they could have reported anytime in 2014, but the fourth quarter was the last they could use, so most of our practices are now reporting and are in their 90-day period now. And the major reason they’re struggling is that a lot of their vendors were not timely enough. Our physicians’ vendors were upfront and said we’re not ready. But the flexible rules that came out in August for Stage 1, allowing them to report this year under Stage 1. And that threw a curveball to the vendors, because a lot of them had updated their products to only deliver Stage 2, and they had to rearrange their products to handle Stage 1 for this fourth quarter.
The overall challenge is the pace of change. And meaningful use is doing two things. First, it’s causing the vendors to expand all their resources on meaningful use, and therefore, they’re expending all their resources on MU. And some are saying it’s hampering vendors’ ability to innovate right now.
Also, most of the EMRs we’re using now have gone through 20 years of development cycles. And Cerner and Epic and everyone else, have expanded and amplified their offerings. But it may very well be now that from a competitive standpoint, there won’t be a willingness on the part of a vendor to enter the market. People are looking for whole solutions. And I have more conversations than you can imagine with clinicians who want to see everything on one screen. And most of the ones selling today are going to e doing that as well.
What policy, leadership, and governance directions is CHIME headed in, in the next couple of years?
We’re going to continue to do things that we’ve been doing for our membership, including our expansion into subgroups for chief information security officers, chief application officers, and chief technology officers
What does the CHIME membership most need right now?
We create the opportunities to learn from each other and cluster around communities. And that’s why we’ve redesigned “MyCHIME,” using NextWave Connect, to create that social media-type of opportunity to let them form their own connections. They might want to get together around a specific topic, and then when they’re done, they’re done. I think we’ll continue to look at those services that will best serve the membership, while adhering to our mission and vision.
Personally, I’m going to be talking about some new initiatives. One of the things I’m working with personally is, for our foundation firms, we’re working on two pilot projects with them to help them establish advisory boards form within the CHIME membership. We’ve found that some of the smaller foundation firms, vendors, may not have the expertise to do that. But we’ll provide the service to the foundation firms to do that. We’ve also recreated the lead forums. We did one in DC and another one combing up soon in Houston.
What would you like to see happen on the policy front in the next few years?
I have a pet project around patient identity. I came from Indiana, where we had really smart people smart HIE. And we had an HIE [health information exchange] created by Regenstrief—they had created certainty around matching patient data with data requests. And the duplicate record thing is really difficult—it’s difficult to make sure we’re accurately identifying folks. Let me give you an example: I have a friend in Indiana who has the exact same name as her sister in law. And whenever either goes into the hospital, someone screws it up. What’s important there is that her sister-in-law is deathly allergic to penicillin. Imagine if that information were confused between their records. And while a lot of people will say, it’s no really big deal, think about this: my friend in Indiana has end-stage renal disease, and is on dialysis.
So if we’re moving data around, we need to make sure we’re moving the right data, and need to make sure that everybody has the same information. So I believe if we could create some level of positive identification, if we truly want to move the data around, that’s a prerequisite. And we’ve had some conversations with ONC [the Office of the National Coordinator for Health IT] about patient-matching. We don’t use the “forbidden” term of “national patient identifier.” But we’re already doing careful matching, and are effectively moving in that direction.
What should CIOs be doing right now, overall?
They just need to keep current and to network among their peers. The other thing is, if you come up with something that really works, share it. We were going through a Baldrige journey in Indiana, and the point is to borrow or steal shamelessly from people who have done it before you.
It’s like the Japanese tire manufacturers in the 1960s, they went and visited all the top U.S. tire manufacturers and copied their methods, and brought them back to Japan. And they had a process where they would take a tire and spin it at a high speed and with a big metal rod would test the tire to see when it would disintegrate. They could not tear the Japanese tires apart; they exceeded all our quality measures. So the Americans decided they both needed to learn from each other. So I think we need to create these places of learning to share with one another. Even in the town I’m in, we share knowledge with our competitor. To make healthcare better, we’ve got to be willing to share those best practices.