On first blush, you might think Vincennes, Ind.-based Good Samaritan Hospital is just another small community healthcare provider in the heartland of America. At 232 beds, how much could be possibly be happening on the IT front? But upon closer look, it’s clear this organization is different. Good Samaritan offers a range of medical services, as well as some of the most progressive technology available today. Of course, it doesn’t hurt when your CIO has been chairman of the HIMSS board. To learn more about what’s going on at GSH, and pick the brain of a top CIO about HITECH, HCI Editor-in-Chief Anthony Guerra recently talked with Chuck Christian.
GUERRA: Do you advise physicians that they might not like the HTIECH deal, but it’s the best they’re going to get?
CHRISTIAN: Well, I agree with that idea. One neurologist said to me, “Well, when it starts costing me because of decreased reimbursement, then we’ll move.” And so, basically, they are establishing their financial pain point. “When it hurts enough, then we’ll move, but I’m not moving until then.” And I think a lot of physicians are like that, because I don’t think the industry has done a really good job of working with the physicians on the value propositions that are important to them.
And the other thing is I don’t think there has been enough peer-to-peer communication between the physicians and those who have been very successful. Sometimes people just assume that a physician has been successful because he’s a computer geek doc. Well, that’s not necessarily true.
There’s a 10 physician practice about an hour and a half from here in Corydon, Ind. We went down and had a long conversation with their docs, looking at the software they’re using and how they used it, and they’ve been using that EMR for about two years and trying to get a handle on the good, bad and ugly. They have 10 physicians, and they just built a brand new building around the new workflows that they had designed for their electronic medical record. I found it really interesting. There’s no place to sit except in the physician offices and a few other places. Everybody stands because they’re in constant motion anyway. There’s no reason to have a place for them to sit. The gambit of physician adoption runs from very high to not really low, but it’s not as good as it could be. One physician, who really adopted the electronic efficiencies, said, “Look, I don’t work on Saturdays and Sundays anymore. I’m typically out of the office by 6:00 every afternoon, and I’ve increased my patient workload volume by 30 percent.”
GUERRA: That’s pretty impressive.
CHRISTIAN: That’s why I’m going, “Wow, you truly are an ally.” Then he’s got two partners who actually started the practice, who are family practice docs for a long, long time. Well, they’re still using a little paper here and there, more than what they would actually confess to. They’re still doing charts and finishing up stuff on the weekends. They have not gotten the benefits out of it that the others have, and I’m not really sure they want to. They’ve been practicing medicine about 25, 26 years, and this is what they know, and they basically both confessed to say, “We’re going to retire in the not too far distant future, and we really don’t want to spend the time to reengineer everything. We’re doing what we need to do right now, then we’re going to kind of fade away into early retirement.”
I think the paltry amount that the federal government is offering the docs is just a drop in the bucket of what it’s truly going to cost the practices to automate, but it’s something, and something beats the heck out of nothing. So we just need to continue to move forward.
There’s very few insurance companies I know of that will pay a physician for an e-visit, for example. I read this piece just the other day about this mom that got up in the morning, she was a nurse. She worked at a hospital. She has a two year old, and she got him up to take him to daycare. She noticed that he was running a fever and he was screaming, and she pulled out her otoscope. (My wife is a nurse, she needed an otoscope with four daughters). His eardrum was red, inflamed and bulging. Guess what? He’s got an ear infection. So she calls the physician office, and asks him to call in something for the ear infection. “Nope,” he says, “sorry, you’re going to have to bring him in.” So she can’t get the prescription. She picks up the phone, calls her nurse supervisor, “I can’t come in today. I’ve got to take my son to the doctor,” and the doctor can’t see her until 2:00. So the kid misses a day of daycare and the insurance company’s charged $150 for the office visit, the doc spends 35 seconds, looks at the kid’s ear and says, “Yup, you’ve got an ear infection. Here’s your script. See you.”
And it could have been done either over the phone or at a mini-clinic. I recently read an article about mini-clinics that are staffed by caregivers like nurse practitioners, physician’s assistants that have prescribing authority, that have a very narrow band of illnesses that they look at and diagnose and treat effectively. Those mini-clinics don’t require all the trappings of a physician’s office. The mother I described could have gotten the same thing done for $35-40 and still been able to get to work for at least half a day.
GUERRA: How do CIOs prepare their organizations for this future state of healthcare you describe?