Playing it safe doesn’t seem to be the most important concern for Hackensack University Medical Center’s CIO Lex Ferrauiola and CTO Ben Bordonaro. If that was the case, they’d almost certainly leave well enough alone, and Siemens and GE in place. But the duo has other plans — turning HUMC from a medical center held together with interfaces to a truly integrated organization, promoting data transfer across the continuum of care, from inpatient services to ambulatory physician practices. To make that dream a reality, the organization has settled on Epic. And while its vendor of choice comes with a high price tag, Ferrauiola and Bordonaro say you get what you pay for.
AG: So they can see into the hospital system?
BB: Absolutely. So I visit (the practices), and more often than not it’s the subspecialties that usually have the EMRs. They’re the more lucrative practices and things like cardiology specialties and things like that. But we have a lot of family practice docs. So if someone had opted for ASP models to date, the ones that have asked for our help have gone ASP just because they’re not going to have IT people in their shops. They have a five or 10 doc practice. They’re not going hire an IT person for that. So between that and the cost of it, it’s tough for a practice, to be honest. So that 4 percent (adoption) number, I wasn’t surprised when I saw that.
AG: When I think of the practices and why they might be reluctant, three main things come to mind. We talked about cost. The second would be the fear that their productivity is going to take a big dip, which almost everyone says it will. And number three, I’ve seen doctors who are concerned about the hospital being able to see their financial data.
LF: We had that right up front. They would like to buy into essential hosted systems. The big concern is that the hospital or some other physicians would be able to see. That’s something that has to be addressed.
AG: Are hospitals concerned about polluting their data pools with data that came from outside, from a practice? I can’t imagine a world where clinicians would take action off data that was generated somewhere else and actually give medical care based off it. Have you thought about that?
LF: Taking from the physician office?
AG: Allowing any sort of outside data. If you have PHRs, people are going to be …
BB: I was going to say, welcome to the world of PHRs.
AG: Right. People are going to be coming in with PHRs, are you going to take that into your ED system and upload it?
BB: Microsoft will run the world (laughing).
AG: Right. So you have PHR data, you have insurer data, which is coming from claims, and then you have ambulatory-generated data. Are you ever going to let outside data into your systems?
LF: I think that’s going to be a big liability issue. It would be to the extent of somebody walking into the hospital with a pad of paper with everything written on it. It might be useful to take a look at it, but are you going to do a treatment plan based on it? Are you going to risk liability? I think eventually we’re going to have to move towards that. There’ll have to be faith and trust in the technology and the security and the integrations of the technology before that’s going to happen. I think it’s going to take a long time.
AG: You have to know where each particular piece of data came from.
LF: And is it right. Did the person who entered it, did they make a mistake? When they were prescribing, did they miss a decimal point? Well, just because they entered something into a computer, doesn’t mean they didn’t make a mistake there too.
BB: That happens today on a small level. But today, a patient brings in their meds, and they are still typing into a system. Forget about the typing part, but the patient can be bringing in a med and the doctor doesn’t even know if they're actually taking their med or not. They’re still making those decisions today. It’s going to obviously be more technology driven in terms of doing a data feed. But we have some of those same issues today.