Less than 2% of U.S. hospitals have reached Stage 7, but the honor is trivial compared to what Reese wants to accomplish: convert Sentara into an accountable care organization that delivers better care, improves population health and reduces costs -- the so-called Triple Aim. Analytics is at the center. "We believe healthcare is a data-driven event," Reese says.
Sentara has a dashboard that draws on products from Epic, Microsoft and SAP. The analytics infrastructure takes feeds from clinical departments, materials management, payroll and sources outside the organization. "It's sort of like a blender," Reese says.
Data is one of three flavors: retrospective, based on historical records; dynamic, such as clinical decision support that updates as new information comes in to provide advice at the bedside; and predictive, the most difficult type to harness but with potentially the greatest impact on Triple Aim goals.
"The trick is to convert data to information and knowledge to action," Reese explains. "You want to speed that information to the point of care."
Sentara's road to becoming an ACO is eased because the company has a health insurance plan, so financial incentives are more aligned with outcomes goals than many of its noninsurance competitors. "We can get to the at-risk [payment] model quicker than most," Reese says. That only happens, however, with ready access to clinical intelligence and the right data to feed the intelligence engine, he says.
-- Neil Versel
Here's where things stood when we interviewed O'Rourke earlier this year: With ambulatory care EHRs installed in CHI facilities in Iowa, Kentucky, Nebraska, North Dakota, Minnesota, and Tacoma, Wash., about 70% of CHI clinics had EHRs certified for Meaningful Use. O'Rourke expected the majority of CHI hospitals, which started the process later than clinics, to be online by June.
Like many in health IT, O'Rourke is nervous about the timing of Meaningful Use Stage 2, which begins for hospitals in October. "Much of the industry is in a scramble to get the first stage up for Meaningful Use," he says. "And Stage 1 is fairly straightforward; Stage 2 is a lot more rigorous." He already has teams preparing for Stage 2, while others work on EHR deployment and Stage 1.
While it isn't easy to run an IT department in such a far-flung operation, O'Rourke had plenty of experience working in multihospital systems such as Catholic Healthcare West and Triad Hospitals before joining CHI in 2007. Reporting to him are regional CIOs who supervise the work in each region. CHI ties it all together through an IT steering committee that includes C-suite execs from all divisions.
O'Rourke's challenge is ensuring that the pace of implementation is as fast as possible while making sure clinician adoption doesn't fall behind.
-- Ken Terry
The hospital attested to Stage 1 Meaningful Use for Medicaid in 2011 and for Medicare in 2012, and it's looking to reach Stage 2 as soon as the measurement period opens for inpatient care in October. It's moving quickly on Stage 2 to free up resources for ICD-10 in 2014. Getting to Stage 2 of the federal electronic health record incentive program will require some "heavy lifting" at Methodist.
Marx is a registered nurse, a fact she believes helps her talk with clinicians as a peer and not an adversary, and to gain buy-in more quickly than if she had come solely from the IT world. "Having a clinical background allows the conversation to be a lot more fluid," Marx says.
Communication is crucial because IT teams for the 596-bed hospital are managing a menagerie of IT systems. Methodist has used an Eclipsys (now Allscripts) Sunrise clinical system since 2008, and also runs QuadraMed billing software, and a picture archiving and communication system from DR Systems.
"We feel very comfortable. We're not making any major changes," says Marx, who previously worked for EHR vendor Cerner and for First Consulting Group. Still, as Meaningful Use and other healthcare reforms advance, Methodist must be able to share data with organizations that use different vendors. "We have to learn to live in that environment," she says.
Methodist also is learning to live in an era of patient engagement by making its IT more accessible by consumers. Marx sees patient engagement "as a strategy that has many different layers to it." The hospital already has a portal, which addresses a specific requirement in Meaningful Use regulations, as well as a centralized scheduling and preregistration system. It's considering a social media component.
A mobile app also is on the list. The hospital hasn't started on the app yet but is looking to offer it first for the emergency department and outpatient services. "We think that will be a really critical part to patient engagement," she says.
-- Neil Versel