CMS' Medicare and Medicaid Electronic Health Record Incentive Program has dished out a lot of money to eligible providers — $1.84 billion as of the end of November, to be exact. Roughly 2,900 eligible hospitals have registered for the meaningful use funds, and one of the first hospitals to receive incentive funds was Honolulu-based Hawaii Pacific Health.
CEO Chuck Sted and CIO Steve Robertson lead the four-hospital system in all things health IT, and the concept of being a "meaningful user" of electronic medical records and "e-healthcare" in general is not anything new to them. Through their different backgrounds, they both knew health IT would become a major part of the future of healthcare in the United States. Here, they explain how the health system stayed ahead of the curve, what major health IT goals HPH has for 2012 and how other health systems should try to prioritize their health IT initiatives.
Q: What are some of the big health IT goals you have for this year?
Steve Robertson: The goals today sound a lot more like business goals than IT goals. And while the healthcare environment is constantly changing, our priorities remain consistent. Our top priority is our sustainable healthcare initiative. It's a program that we essentially started a few years before the hubbub of healthcare reform. Its purpose is to really drive clinical integration and connecting our 350 employed and 700 community physicians. For example, this involves our Epic electronic medical record while really focusing on quality on the inpatient and ambulatory side. HIMSS placed us in the top 3.8 percent of the country of where we are at with our EMR and its capabilities. A key part of that is from developing a dashboard, metrics and quality measures and driving significant improvements in these quality measures.
Our second priority, which supports the first, is our HealthAdvantage CONNECT program. This is an EMR solution for our community physicians. Getting our physicians on our Epic EMR system is a huge benefit to our patients and our community as a whole. Being able to share a common clinical record with everyone is going to make our system a lot more robust. Today we've got 60 independent physicians live and running their practice with our EMR, and we've got another 22 contracted for this upcoming year.
Number three is getting our enterprise resource planning system fully deployed. The ERP is going to replace the general ledger, material management, payroll and other revenue cycle functions. The ERP is the last Holy Grail to put in place to get true system integration across the board.
ICD-10 is number four. We're probably not as far as long as we should be, but we might be farther along than other systems. There's a general reluctance to tie into this thing. Where we are today is each of our facilities has certified trainers for ICD-10, and we've trained portions of our staff. We also have an ICD-10 project charter and a steering committee, and we've done a gap analysis and are defining the budget right now. You need to look at what the financial impact is going to be — it's going to be pretty significant. From a revenue point of view, I don't think we know yet, but from a project-cost point of view, it will be in the $2 million to $3 million range.
Chuck Sted: I spent 18 years in public accounting and was a partner at Ernst & Young. I also was at Bank of America Hawaii for five-and-a-half years. When I came into healthcare 14 years ago, I came in with a healthy appreciation of IT, as it as an enabler of everything else.
From a CEO perspective, my main responsibility is that we have to make sure we have the right human and financial resources allocated to health IT. Then when we get our leader, Steve, and his team in place along with the teamwork that goes on with all the other business, administrative and clinical people in the organization, then I stay the heck out of the way.
Steve is the CIO, but he's also the head of revenue cycle management. From my point of view, it's really the way to go. You see revenue cycle assigned up to the finance side, but as far as I'm concerned, the revenue cycle is inextricably intertwined with IT.
The other responsibility I have is the pacing. One of our baseline core competencies at HPH is prioritization and managing change wealth. Physician leadership is the second floor. The third floor is Epic, or IT more broadly, and the others are quality, service excellence and employee engagement. My job is to make sure we don't get too much going at one time.
Q: I noticed you didn't mention meaningful use at all, but that's probably also because you are pretty far along with meaningful use goals. Specifically, how far along is HPH with meaningful use, and what are some of the biggest benefits you've seen for being a "meaningful user"?
Steve Robertson: We're actually one of the first hospitals in the country to be paid by Medicare [for meaningful use]. We received just under $4.4 million for all our hospitals that qualify for the Medicare incentive. We attested in June and were paid in August. As far as the benefits go, we were already on track for receiving meaningful use incentives, so we didn't let it drive our direction. We already set our path a couple years before that came. Meaningful use was more of an administrative thing than anything. The benefit is we received the stimulus money for what we were going to do anyway, and it actually allows us to invest more to support other parts of our healthcare initiative.
Our physicians haven't been paid yet. However, we've attested for more than 85 percent of the employed eligible physicians, and we expect to get paid early next year. The real challenge has just been the reporting side.
Q: What are some of the ways you help your physicians, nurses and other staff members buy into the health IT wave?
Steve Robertson: That's a great question, but I have to give you a little bit of background. Hawaii Pacific Health is the result of a merger between three different health systems in 2001. All of them were operating independently, and when we made the decision to consolidate systems onto Epic, that was a really disruptive innovation. As we went around and phased the "go-live," we drove the culture by working individually with nurses and physicians, driving to a common system and workflow. It really galvanized relationships and built trust. That sort of back-and-forth, constant communication and teamwork built up a core that helped us gain credibility once systems were installed. There's really no magic to it at all. It's that constant partnership, communication, transparency and really just listening.
Chuck Sted: We've had this conscious engagement from 10 years ago to have a culture of teamwork and to put aside the historical culture in healthcare that many organizations are still burdened with situations where the administration and physicians don't work closely together. If you look at how the Cardinals won Game 6 of the World Series, it's because they played as a team. If you look at how the Red Sox crumbled before the playoffs, it's because they didn't play as a team.
Q: What unique technologies has HPH installed, and how do they improve your system?
Steve Robertson: In terms of technology as a whole, there's nothing really new and exciting. Healthcare is generally 20 years behind the times. HPH is close to being caught up. We are proud of being able to have a web portal [MyHealthAdvantage] to support our patients and engage them.
In terms of infrastructure and networks and bandwidth, there's just nothing special or cool that I could really point to brag about. We built systems that provide complete and total transparency on every workflow we have, and I'm really proud of this. We have revenue cycle systems where data and information is instantly available. I can log into my own portal, and I can spot shifts and trends.
You mentioned ICD-10 is one of your major HIT goals for this upcoming year. How do you see it playing out?
Steve Robertson: [ICD-10] is a major distraction. When you look at what we're trying to achieve, ICD-10 will derail that effort and change the entire focus to only supporting the administrative burden that does nothing to improve care. From the administrative point of view, it enhances recording capabilities, but we have to focus on basics through EHRs.
ICD-10 needs to be delayed two years. If you talk to healthcare CIOs and most healthcare CEOs, I'd be surprised if they wouldn't be supporting a delay of at least two years. It will require a massive change, and it will come at a time when health systems are likely to be weakest.
We're constantly faced with big changes and there's always some resistance, but I think that if ICD-10 came after meaningful use, you wouldn't get the resistance you see today.
Q: What kind of role does mobile technology, such as smartphones and tablets, have within HPH?
Steve Robertson: We have iPhones and tablets that allow physicians to have abbreviated access to medical record portions of patients. They love it, but repeatedly, newer technologies have the tendency to be a fad or a plaything. Wide rollouts are generally not a good idea until you really get it in place and you see how it's used effectively.
Chuck Sted: Everywhere there is an interaction going between the clinician and the patient, there's always a computer. One of the benefits is that the clinical person who is attending to the patient is physically present with patient more often, that's what patients may want and that gets reflected in the patient satisfaction score. This is at the bedside but also in the primary care physician's office.
If I do go into a PCP's office or a specialist's office, I'm going through the usual routine, nurse checks the blood pressure, initial questions in the exam room, but they are sitting there with the keyboard typing. When the doctor comes in, he is talking with me, making his entries right in front of me, and when our work is finished — when he types his final keystroke — he puts his electronic signature on the note, and he's done. He doesn't have to go back at the end of the day. It's already off to the billing department and available to the next clinician who sees me.
Q: Because HPH is so far along in its health IT initiatives, particularly meaningful use, what kind of advice would you give to other hospitals that may be struggling in their HIT efforts?
Steve Robertson: My response would be it's really important to be steady on course. Given our very hectic [healthcare] environment, distractions are so common. Prioritization is so critical. Take one step at a time and stay focused on getting the job done. There's a lot of different ways to do this: open transparency, partnership, communication are really critical.
If you're an IT guy and you're focused on only IT things, you absolutely fail. From a CIO's point of view, IT and technology aspects should occupy less than 10 percent of your time. Most CIOs would readily recognize that, but we're at a pivotal historic change with health IT. The role of the CIO is radically different than what it was five to 10 years ago. If you're a health system and you're not focused on what's happening with healthcare and enabling that kind of ability to achieve goals, that system is going to fail.
Chuck Sted: I completely agree with Steve. From a CEO's perspective, my advice would be to be very articulate about a strategic plan, and make your decision about IT in the context of the strategic plan. Don't let yourself get taken off course by fads.
CEO Chuck Sted and CIO Steve Robertson lead the four-hospital system in all things health IT, and the concept of being a "meaningful user" of electronic medical records and "e-healthcare" in general is not anything new to them. Through their different backgrounds, they both knew health IT would become a major part of the future of healthcare in the United States. Here, they explain how the health system stayed ahead of the curve, what major health IT goals HPH has for 2012 and how other health systems should try to prioritize their health IT initiatives.
Q: What are some of the big health IT goals you have for this year?
Steve Robertson: The goals today sound a lot more like business goals than IT goals. And while the healthcare environment is constantly changing, our priorities remain consistent. Our top priority is our sustainable healthcare initiative. It's a program that we essentially started a few years before the hubbub of healthcare reform. Its purpose is to really drive clinical integration and connecting our 350 employed and 700 community physicians. For example, this involves our Epic electronic medical record while really focusing on quality on the inpatient and ambulatory side. HIMSS placed us in the top 3.8 percent of the country of where we are at with our EMR and its capabilities. A key part of that is from developing a dashboard, metrics and quality measures and driving significant improvements in these quality measures. Our second priority, which supports the first, is our HealthAdvantage CONNECT program. This is an EMR solution for our community physicians. Getting our physicians on our Epic EMR system is a huge benefit to our patients and our community as a whole. Being able to share a common clinical record with everyone is going to make our system a lot more robust. Today we've got 60 independent physicians live and running their practice with our EMR, and we've got another 22 contracted for this upcoming year.
Number three is getting our enterprise resource planning system fully deployed. The ERP is going to replace the general ledger, material management, payroll and other revenue cycle functions. The ERP is the last Holy Grail to put in place to get true system integration across the board.
ICD-10 is number four. We're probably not as far as long as we should be, but we might be farther along than other systems. There's a general reluctance to tie into this thing. Where we are today is each of our facilities has certified trainers for ICD-10, and we've trained portions of our staff. We also have an ICD-10 project charter and a steering committee, and we've done a gap analysis and are defining the budget right now. You need to look at what the financial impact is going to be — it's going to be pretty significant. From a revenue point of view, I don't think we know yet, but from a project-cost point of view, it will be in the $2 million to $3 million range.
Chuck Sted: I spent 18 years in public accounting and was a partner at Ernst & Young. I also was at Bank of America Hawaii for five-and-a-half years. When I came into healthcare 14 years ago, I came in with a healthy appreciation of IT, as it as an enabler of everything else. From a CEO perspective, my main responsibility is that we have to make sure we have the right human and financial resources allocated to health IT. Then when we get our leader, Steve, and his team in place along with the teamwork that goes on with all the other business, administrative and clinical people in the organization, then I stay the heck out of the way.
Steve is the CIO, but he's also the head of revenue cycle management. From my point of view, it's really the way to go. You see revenue cycle assigned up to the finance side, but as far as I'm concerned, the revenue cycle is inextricably intertwined with IT.
The other responsibility I have is the pacing. One of our baseline core competencies at HPH is prioritization and managing change wealth. Physician leadership is the second floor. The third floor is Epic, or IT more broadly, and the others are quality, service excellence and employee engagement. My job is to make sure we don't get too much going at one time.
Q: I noticed you didn't mention meaningful use at all, but that's probably also because you are pretty far along with meaningful use goals. Specifically, how far along is HPH with meaningful use, and what are some of the biggest benefits you've seen for being a "meaningful user"?
Steve Robertson: We're actually one of the first hospitals in the country to be paid by Medicare [for meaningful use]. We received just under $4.4 million for all our hospitals that qualify for the Medicare incentive. We attested in June and were paid in August. As far as the benefits go, we were already on track for receiving meaningful use incentives, so we didn't let it drive our direction. We already set our path a couple years before that came. Meaningful use was more of an administrative thing than anything. The benefit is we received the stimulus money for what we were going to do anyway, and it actually allows us to invest more to support other parts of our healthcare initiative.
Our physicians haven't been paid yet. However, we've attested for more than 85 percent of the employed eligible physicians, and we expect to get paid early next year. The real challenge has just been the reporting side.
Q: What are some of the ways you help your physicians, nurses and other staff members buy into the health IT wave?
Steve Robertson: That's a great question, but I have to give you a little bit of background. Hawaii Pacific Health is the result of a merger between three different health systems in 2001. All of them were operating independently, and when we made the decision to consolidate systems onto Epic, that was a really disruptive innovation. As we went around and phased the "go-live," we drove the culture by working individually with nurses and physicians, driving to a common system and workflow. It really galvanized relationships and built trust. That sort of back-and-forth, constant communication and teamwork built up a core that helped us gain credibility once systems were installed. There's really no magic to it at all. It's that constant partnership, communication, transparency and really just listening.
Chuck Sted: We've had this conscious engagement from 10 years ago to have a culture of teamwork and to put aside the historical culture in healthcare that many organizations are still burdened with situations where the administration and physicians don't work closely together. If you look at how the Cardinals won Game 6 of the World Series, it's because they played as a team. If you look at how the Red Sox crumbled before the playoffs, it's because they didn't play as a team.
Q: What unique technologies has HPH installed, and how do they improve your system?
Steve Robertson: In terms of technology as a whole, there's nothing really new and exciting. Healthcare is generally 20 years behind the times. HPH is close to being caught up. We are proud of being able to have a web portal [MyHealthAdvantage] to support our patients and engage them.
In terms of infrastructure and networks and bandwidth, there's just nothing special or cool that I could really point to brag about. We built systems that provide complete and total transparency on every workflow we have, and I'm really proud of this. We have revenue cycle systems where data and information is instantly available. I can log into my own portal, and I can spot shifts and trends.
You mentioned ICD-10 is one of your major HIT goals for this upcoming year. How do you see it playing out?
Steve Robertson: [ICD-10] is a major distraction. When you look at what we're trying to achieve, ICD-10 will derail that effort and change the entire focus to only supporting the administrative burden that does nothing to improve care. From the administrative point of view, it enhances recording capabilities, but we have to focus on basics through EHRs.
ICD-10 needs to be delayed two years. If you talk to healthcare CIOs and most healthcare CEOs, I'd be surprised if they wouldn't be supporting a delay of at least two years. It will require a massive change, and it will come at a time when health systems are likely to be weakest.
We're constantly faced with big changes and there's always some resistance, but I think that if ICD-10 came after meaningful use, you wouldn't get the resistance you see today.
Q: What kind of role does mobile technology, such as smartphones and tablets, have within HPH?
Steve Robertson: We have iPhones and tablets that allow physicians to have abbreviated access to medical record portions of patients. They love it, but repeatedly, newer technologies have the tendency to be a fad or a plaything. Wide rollouts are generally not a good idea until you really get it in place and you see how it's used effectively.
Chuck Sted: Everywhere there is an interaction going between the clinician and the patient, there's always a computer. One of the benefits is that the clinical person who is attending to the patient is physically present with patient more often, that's what patients may want and that gets reflected in the patient satisfaction score. This is at the bedside but also in the primary care physician's office.
If I do go into a PCP's office or a specialist's office, I'm going through the usual routine, nurse checks the blood pressure, initial questions in the exam room, but they are sitting there with the keyboard typing. When the doctor comes in, he is talking with me, making his entries right in front of me, and when our work is finished — when he types his final keystroke — he puts his electronic signature on the note, and he's done. He doesn't have to go back at the end of the day. It's already off to the billing department and available to the next clinician who sees me.
Q: Because HPH is so far along in its health IT initiatives, particularly meaningful use, what kind of advice would you give to other hospitals that may be struggling in their HIT efforts?
Steve Robertson: My response would be it's really important to be steady on course. Given our very hectic [healthcare] environment, distractions are so common. Prioritization is so critical. Take one step at a time and stay focused on getting the job done. There's a lot of different ways to do this: open transparency, partnership, communication are really critical.
If you're an IT guy and you're focused on only IT things, you absolutely fail. From a CIO's point of view, IT and technology aspects should occupy less than 10 percent of your time. Most CIOs would readily recognize that, but we're at a pivotal historic change with health IT. The role of the CIO is radically different than what it was five to 10 years ago. If you're a health system and you're not focused on what's happening with healthcare and enabling that kind of ability to achieve goals, that system is going to fail.
Chuck Sted: I completely agree with Steve. From a CEO's perspective, my advice would be to be very articulate about a strategic plan, and make your decision about IT in the context of the strategic plan. Don't let yourself get taken off course by fads.
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