Physician IT Governance and Patient-Focused RCM | CHC17 Day 2

Published on 10/9/2017

On Monday, we concluded the Cerner Physician Community meeting and celebrated the official kick-off of the Cerner Health Conference (CHC). We stayed busy with informative sessions throughout the day, and received a hearty welcome from our first general session speakers. Here are today's highlights:

One record, one patient, one plan: the future of patient-focused provider networks

We're entering an era that will require seamless coordination of care and an emphasis on consumerism. For health care organizations, this means that affiliating with the right IT providers and building a strong, integrated care delivery network will be vital.

Having one record, one patient and one plan was the consistent message from Edwina Mallery, the assistant vice president of information systems at Lafayette General Hospital, and David Coe, the senior director of population health technology at Banner Health.

"We don't want several different patient portals," said Mallery. "Scheduling, medication management, their health care needs - [that should be] all in one record."

"We want to make our integration available to consumers," Coe added. "Bringing forward a consumer model is very important moving forward in health care."

Strategies for successful physician IT governance

Leadership from Roper St. Francis and Centra Health discussed how having a governance plan in place is essential to their organizations' implementation projects. Dr. Mary Lou Applebaum, associate CMIO at Roper St. Francis and Dr. Jeanne Ballard, CMIO at Roper St. Francis, shared their experiences with big bang implementation, while Dr. John-Paul Jones, CMIO at Centra Health, shared some best practice strategies for health care organizations looking to improve the path toward successful governance.

"Why do you want good governance?" he asked a standing-room-only session. "It's your only defense against the dark forces."

With that, Jones presented four "secret spices" to good governance:

Salt - Organizations need to provide guidance aligned with the mission, values and purpose of their health system. "Salt gives you direction," he said. "Whether it's excellent care every time, whatever your mission is - make sure the process supports that mission."

Pepper - Hospital leadership should be conscious of including a mix of viewpoints and experiences. Diversity means not limiting involvement to friends only.

MSG - This is the preservation piece - good governance must preserve the focus of the IT product.

Flour - Accountability is the "flour" of good governance, Jones said. "Accountability binds us together," he said. "If you're part of the governance, own it -- raise your hand. If you're aligned with your mission, at least you know you've done right. Be accountable."

"Good governance is not about making the one right decision," he continued. "It's the process and place to making and implementing those decisions."

Ballard gave organization-specific examples of how Roper St. Francis had incorporated those guiding principles.

"We started out with what meant the most to our organization," she said. "Then we set the infrastructure from there. We wanted a governance structure that ensured that the group that was meeting knew they were empowered to make decisions, and we defined these roles."

Our governance vision reflected our organizational mission: "Healing all people with compassion, faith and excellence," Applebaum added. "We wanted our guiding principles to be on putting the patient first and focusing on quality."

Value-based care, reimbursement and a patient-focused revenue cycle

We heard from a panel of Cerner executives on strategies for managing health and care in the era of the Affordable Care Act while considering the proposed changes of the Trump administration. Don Paulson, Cerner's vice president of revenue cycle, shared expertise on value-based reimbursement, managing margins while decreasing cost and using technology to automate clinical and financial processes. Dr. Tinu Tadese, a senior physician executive at Cerner, delivered the physician perspective and discussed how to balance these efforts with engaging and educating the consumer to create an optimal, satisfactory care experience.

"Revenue cycle is often the first and last person a patient talks to," Paulson said, adding that it's all too easy for the patient to become confused and overwhelmed when it comes to billing due to lack of education. "Either we [educate], or our patients don't know what to do. We need to guide people, and we have an obligation to teach our patients as best we can."

Understanding challenges and opportunities from a clinical, financial and consumer perspective, Paulson said, can help organizations achieve a more holistic mindset to better prepare for the future of health care.

"Our biggest problem in revenue cycle is that we know too much, and we expect the rest of the world - including patients - to understand as much as we do. And they don't always," he went on. "But if we educate them, the outcomes in patient engagement and satisfaction will pay for itself."

A cognitive informatics approach to the opioid epidemic

The opioid epidemic is sweeping the country, and regional health care systems are facing the need to make actionable decisions. By using cognitive informatics, MedStar Health has adapted novel workflow and policy approaches that have assisted in impacting clinical outcomes and practice.

We heard from several speakers who discussed a suite of programs to improve and monitor safety within the health care system, including going dilaudid-free in the emergency department, monitoring out-of-hospital overdoses and the prescribing of naloxone for patient use and other health IT safety surveillance regarding the use of opioids.

"Seventy-five percent of oxycodone errors happen during the ordering process," said Dr. A. Zach Hettinger, medical director at the MedStar Health National Center for Human Factors in Healthcare on the need to fix errors in the ordering process of opioids. "Thirty-seven percent of oxycodone IR-ER errors reached the patient."

Hettinger discussed human factors engineering in health care, when a process is designed for humans, with human error factored in.

"You can improve health care quality, efficiency, reliability and safety by applying human factor principles," Hettinger said.

Redesigning EHR training with web-based tools

Leadership from Emory Healthcare described the complete overhaul of its training program as they said goodbye to the traditional model of classroom-based training.

Dr. Julie Hollberg, CMIO, discussed how Emory leverages electronic tools like web-based learning management and data to measure the time physicians and clinicians spend using the EHR and to determine whom to target for 1:1 coaching.

"Our goal is to be the concierge to those doctors to reduce frustration," said Hollberg. "This is not one and done. Investing in your training plan is essential."

Dr. Willie Smith, associate inpatient medical director of information services, discussed the importance of taking Emory's training program on the road. This included several tactics, emails, newsletters, intranet webinars and pop-up EHR visits.

"It is important to socialize the program with all stakeholders to get buy-in," Smith said.

Elizabeth Sprouse, senior patient portal and informatics program manager, noted how Cerner's eCoach is at the heart of their new training program, and Cerner Advance data also provided data-driven coaching examples for training.

The impact of a strategic services partnership on revenue cycle performance

Adventist Health and Cerner share a long-term relationship that grew in 2013 to include the full suite of Cerner's revenue cycle management (RCM) services, designed to enhance performance, optimize efficiencies and standardize operations across the organization.

Cerner's Paulson described the structure of the relationship across the front, middle and back of the revenue cycle, as well as outcomes Adventist achieved. "When you can hire good people with good processes," he said, "you will get good outcomes."

Teri Meintel, executive director of patient access at Adventist Health, discussed how better patient access means building a culture of service.

"What our patients need is to be empowered about their health care," she said. "We need to talk to patients as advocates for them, not collectors after them."

Having conversations with patients is about cultivating lifelong relationships, Meintel added, and it's important to communicate to patients the information they need, especially as it relates to financials.

Remembering Neal Patterson and thinking about the future of health care

Dick Flanigan, senior vice president of Cerner ITWorks, greeted the crowd of 14,000 Cerner clients, partners and associates filling the Sprint Center in downtown Kansas City by sharing some thoughts on co-founder Neal Patterson, who passed away in early July.

"All of us felt his passion to create an open, interoperable health system that we could all take advantage of," Flanigan said. "He wanted us to change health care in partnership with our clients and our communities."

In a moving video tribute, we heard Patterson himself sharing some of the wisdom that he brought to Cerner: "Health isn't where the doctors and the nurses are," he said. "Health care is where we are as a population. All health care has to be person-centric, and the people are us."

Flanigan ended his address with a call to action: "From Neal's perspective, it was never about the past - it was about what happens next," he said. "Neal is here tonight. He's in your thoughts, in your hearts and your actions."

We also heard from Dr. Kurt Newman, a recent winner of the HIMSS Davies award and the president and CEO of Children's National Health System in Washington, D.C., on the special need for pediatric care. Newman's mission has been to create an environment that is as conducive as possible to healing and hope, and he called on health care leaders to focus more on pediatric care, because children are our future.

Dr. Mark Briesacher, the senior vice president for Intermountain Medical Group, shared his own story about Neal, and called on attendees to solve health care problems not only for the patients, but for their family and friends. David Bradshaw, executive vice president, chief strategy officer and CIO at Memorial Hermann Health System, challenged the health care industry to use technology to become frictionless. Finally, Cerner Chief of Staff Jeff Townsend shared his vision for innovation: "It isn't just technology," he said. "It's about how we engage with each other and how we frame a vision for the future."

Following the general session, CHC attendees strolled from the Sprint Center to the Kansas City Convention Center to celebrate the opening of Cerner's Solutions Gallery.