AG: You mentioned two physician groups involved with the hospital. Are they employees of the hospital?
AB: No, actually they’re not. I am working with Columbia physicians on it.
AG: So, most of the physicians that we’re talking about here have admitting privileges, but they’re not employees.
AB: Most of them, yes.
AG: And one of the groups has chosen Epic and one, Allscripts. Were those in any way underwritten by the hospital using the Stark relaxations?
AB: No, they’re not.
AG: Ok, so they were paid for by the groups themselves.
AB: Right. We might consider such a thing in the future, extending ours to other community-based physicians that don’t have a physician organization behind them, but we haven’t gotten there yet. I also have other physicians that admit here that don’t belong to either of those POs (physician organizations).
AG: Is the Epic group, are they integrated with the Eclipsys inpatient system?
AB: Yes, we’ve done a little bit of the integration on both fronts actually, even with Allscripts. We are exchanging documents between the systems, so when a patient gets admitted, the hospital ADP message goes over to the PO ADP system or registration system. I guess is a better word for that, which is the GE registration, the old IDX system. That will generate a trigger to Epic. Epic creates a summary document we call the snapshot, and that appears in Eclipsys as a note. So, you get a summary of medications, problem list, whatever is relevant from there, and at the patient discharge, we started sending the discharge summary from Eclipsys over to Epic, and we’re doing the same thing uptown.
AG: You mentioned that you’re considering underwriting systems for some of the smaller practices in the area that are not part of the POs. Does the fact that, under HITECH, they will receive the financial benefit for the using the systems you’ve paid for, diminish your interest in doing that?
AB: Well, I don’t think so because the motivation for us, and it really goes back to why go forward with HealthVault and why move ahead with RHIOs, is if the patients moved between the organizations, you still have to make the connections. Our referring physicians very much want to get the information back from the hospital, so we can mail a discharge summary back to the practice or we can make it available through a system. If every one of those physicians buys their own system, that integration is going to be a little more difficult. If I can sleep in more and keep my differences to three or four or five major vendors, I think it’s going to be an easier process for us to start exchanging information. So, I think that’s the major reason not to have every small office have its own system.
AG: I think you touched on a fascinating new dynamic, which came into place when HITECH was passed. We could have a situation where the new stimulus money means physicians are de-incentivized to work with the hospital on this. They can get the money directly themselves, and some of them are reluctant to be beholden to the hospital anyway. So now you remove the hospital being in the position to orchestrate the purchase with an eye toward inpatient integration. We could have an integration nightmare which will be the CIO’s responsibility to work out.
AB: That’s another reason for me for doing something like HealthVault. We have a physician practice up in Westchester that refers a lot of patients down to the Columbia campus for heart surgery, and they’re on the GE Logician system. So, now that I’ve sent this CCR record to HealthVault via the patient, we’re creating the ability for the patient to now push that CCR record up into GE Logician and, therefore, move that same data through their own control back to their physician. That’s another route.
I think one of the things we’re trying to do here at NYP is we’re working on a RHIO, and we’ll see how that goes. We’re working with our own physicians and looking at things like HealthVault so that there are other mechanisms to empower patients and exchange information. I’m not sure where we’re going to end up, but if we explore all of our options, we’re going to help the industry learn some things. We’ve already automated the hospital, so we’re in a really good position to try to help the industry see what can happen. If I can also get that summary record back to the physician, and I’m going to have that working by June, that will be a beautiful thing for us because the patient will have the ability to give it back to their primary care physician.
AG: You are one of the few organizations that is probably qualified to receive HITECH money today, but most hospitals, especially smaller ones, will have to scramble to qualify for that money. Being that’s the case, do you just keep doing what you’re doing and then use the reimbursement money for other things?
AB: We need to find out what meaningful use is exactly going to be, but I have told my hospital leadership, I think no matter how they define that, given enough notice, we can make sure we fit in that package because we automated just about everything we could. We would use that money when it starts flowing in, in 2011, to fund the next parts of the project, and I think that’s what the stimulus package is for. I mean, getting the EMR up is step one. That does not create a connected healthcare system. That does not create a more efficient healthcare system. We’re trying to push the envelope to the things that do that for you, and getting more money to make that go faster is an important thing for us. Capital money in hospitals is at a premium, this year more than ever before for me, so the additional funds will allow us to do more. I can do more on outcomes if I get more money to take this data that we spent so many years getting electronic and being able to do more with it.
AG: Given that many hospitals are both lacking IT and cash-strapped, how are they supposed to meet these deadlines for incentives?
AB: Well, that may be a problem for greater minds than mine, but I do know a lot of hospitals. We’re part of the healthcare system, and I’ve assisted some of our system hospitals in getting their clinical systems going. They probably, right now, don’t fall in the 2 percent bucket (of hospitals with deep and wide IT usage), but a few of them are well on their way. So there probably are a significant number of places that have started, and over the next year, year and a half, depending how big of a hospital you are, you could probably move the ball down the field if the leadership of the organization is willing to spend a little money, anticipating they’re going to get reimbursed for it. I think you’ll see it happen. I’m very optimistic. I think you’ll see a lot of movement.