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Moving Forward on the New Healthcare in Western New Jersey

September 17, 2012
by Mark Hagland
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At Hunterdon Healthcare, executive leaders are moving forward on a broad range of initiatives

Hunterdon Healthcare Partners is a multispecialty group with over 165 providers, in Flemington, N.J. It is half-owned by an independent physician association, and half-owned by Hunterdon HealthCare System, an integrated system that encompasses a 178-bed hospital, 30 patient care locations, and over 2,000 employees, in Hunterdon County in western New Jersey. Jeffrey Weinstein, executive director and CEO of Hunterdon Healthcare Partners, and Glenn Mamary, vice president and CIO of Hunterdon Healthcare, have been collaborating on a variety of strategic initiatives of late. Among these are the creation of a patient-centered medical home network, with 24 Hunterdon Healthcare Partners clinic sites designated as PCMHs by the National Committee on Quality Assurance (NCQA). The leaders at Hunterdon are also participating in a statewide health information exchange (HIE), among other efforts.

Weinstein and Mamary spoke with HCI Editor-in-Chief Mark Hagland recently regarding their combined organizations’ efforts and current perspectives. Some of their comments were also included in the October cover story on the top strategic IT challenges facing medical groups. Below are excerpts from that interview.

Your physician organization has attested on behalf of your physicians for meaningful use, correct?

Glenn Mammary: Yes, we attested to Stage 1 of meaningful use at the end of last year, on behalf of 75 physicians. At the same time, we were able to achieve patient-centered medical home designation from NCQA for 24 of our physician locations.

Glenn Mamary

What is the biggest strategic IT challenge for you right now?

Jeffrey Weinstein: Our biggest challenge is taking the data that we’ve collected and starting to put it into a format so that we can use it to help manage populations, to improve the health of our communities.

Jeffrey Weinstein

Mammary: And at some point, really being predictive in our analysis as well. And because we’ve been on our EMR for so many years now, we’ve got a database that we could leverage, because the tools are so mature out there.

What other areas are top-of-mind for you right now?

Mamary: Among other things, we’re trying to move forward on data integrity issues. Some of the issues in that area include making sure that people understand the meaning of the data we’re capturing, and that people are trained to correctly capture the data. Fortunately, we’re all on the NextGen system, so the capture element isn’t that difficult on the practice side. It’s on the hospital side where I find that we have some issues, because of multiple systems and vendors.

The other thing is that, in the hospital, I have to provide data to over 30 outside sources, whether state or federal. They come up with these little state-level names of pieces of data that mean something to New Jersey, for example; and then the information systems are required by our contract to capture those data elements. And inevitably, New Jersey calls something by a name that is different from what it’s called in another state. And there are so many points of data entry into the system.

So capturing a piece of data in a consistent way is a challenge, and is one of the lessons we’ve learned. So we’ve gone back and made more fields required fields, so people don’t just skip by them. So we’re required to say that a patient doesn’t actually have a referring physician, if they don’t. And we needed more analytics people to find things out. We’ve got tons of data, but we’re really trying to turn that data into information. We’re using the Ensemble solution in that area. And having a financial systems analyst, a clinical systems analyst, and also working with the customers, you need to put all those systems in place, to make sure you have good data integrity, and to make sure that all your processes are correct.

Do you have a CMIO at the health system level?

Mamary: My leadership team—I have a mostly full-time CMIO for the health system; then a very-part-time CMIO, mostly dedicated to the NextGen team (day and a half); six RNs, and a pharmacist—so I have clinical-background folks who are working with the improvement processes. I have a HIPAA privacy officer, and I have a HIPAA security officer. And we now have an imaging informatics person to help make sure the images are part of the EMR, and that those are built into the data repository. So another part of the strategy is to make sure that radiology, cardiology, pathology, the sleep center, etc., are brought in. And we have 12 people working just on NextGen.

What will you need to do, and what will happen, in the next two to three years?

Weinstein: [The processes around data have] got to be seamless. We’ve got to get to the point of being able to use data regardless of where it sits. If I’ve got a patient in one of the facilities or practices, and she goes elsewhere, I’m still not convinced that that person is being treated outside our service area. We’re a long way off from the banking or financial services world.

Mammary: So the maturity of the health information exchange has to come, in order to be able to do that.

Weinstein: We can go to an ATM machine and we don’t think twice about putting that piece of plastic in there, and that we’ll get money out of it. But we’re still uncomfortable with the fact that someone all the way around the world might get access to my health records.

Mammary: We’re going to get to stage 7 on the HIMSS Analytics schematic. We’ve got bits and pieces up to like 5 ½… We’re just going live with CPOE this fall. So at the end of this year, we’ll be at 5.5. And we’ll probably be at stage 7 in two years. Parts of stage 7 we already have already, in terms of ambulatory continuity.

Is your health system participating in a statewide HIE?

Mamary: That’s correct, Jersey Health Connect HIE, a statewide HIE. It includes participation from Atlantic Health, St. Barnabas, CentraState, Hackensack, JFK Medical Center, Somesert Medical Center, St. Peter’s Medical Center, Trinitas, St. Claire’s Hospital, Robert Wood Johnson, Holy Name, and Children’s Specialized Hospital, and us. There are 13 organizations altogether that are involved, and the HIE is using RelayHealth as its core IT solution.

Is the HIE live yet with data exchange?

Mammary: We’re going live this coming quarter; a couple of the hospitals are already live. Atlantic Health and JFK and Somerset are live on this now. We’ll be live by October.

What have the biggest lessons learned been so far?

Weinstein: First of all, when you think you’ve figured out how much money you need, double it! But the biggest lesson really is that the amount of time and effort required to do all this truly are bigger than you’d think. And people say to us, we want to create tomorrow what it’s taken you 13 years to build. And I’ll say to them, you can start tomorrow, but give yourselves at least 10 years.

Mammary: And I’ve been in healthcare IT since the late 70s. And I’ve never seen this exponential level of change and demands [on provider organizations]. With ICD-10 and meaningful use and healthcare reform, and dealing with the state regulations, and making sure that we spend enough time testing and educating folks, it’s endless. I have never seen anything like this.

At least now, following this summer’s Supreme Court ruling around healthcare reform, there’s policy clarity now, correct?

Weinstein: Yes, I think so. And I think we’ve all come to the realization—I don’t really care who ends up in the White House. I see individual things being changed and tweaked. But we all know at the end of the day, we can’t afford to throw it out (healthcare reform). At the end of the day, we all know that if we don’t find a way to raise the bar on quality and lower costs, we’re going to fail as a nation.

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