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Bill McCoy, M.D.
Chief Medical Information Officer
Metropolitan Health Networks, Boca Raton, Fla.
Wish List Items: Cooperation, Push Technology

Bill McCoy understands that the future of medicine is wrapped in clinical IT But his primary need for the future is not technology. "Cooperation with providers" is how the CMIO describes his most pressing requirement for the future. Metropolitan Health Networks runs a provider services network focused on adult primary care. With 80 employed physicians, the publicly traded company is reimbursed through at-risk Medicare contracts. It also contracts with hundreds of other primary care physicians in some 200 practices.

Metropolitan is transitioning its employed base of physicians to an EHR, from eClinicalWorks, using a vendor-hosted version of the ambulatory software. McCoy figures all the offices will be live on the system by the end of 2014. The practice operates under the patient-centered medical home model, which McCoy describes as "primary care quarterbacking." The IT-rich model calls on primary care physicians to orchestrate care delivery among specialists and uphold various quality measures along the way.

Technology, McCoy says, is not the hurdle to the model's success-getting various external providers to cooperate and share data is. "Some hospitals don't want to give up their data," he says. "If a patient stops at the emergency department, or gets admitted for something unrelated to what we are treating them for, we are at the mercy of the medical records department to send us a discharge summary," he says. "If a patient has been in the local hospital, we want to see that patient in three to five days. But it takes an act of Congress to get the discharge summary."

McCoy's IT arsenal includes some tools to enable better exchange of data. Its eClinicalWorks EHR, for example, includes a secure messaging app built into the system. Hospitals or specialists can participate by signing up through Metropolitan. "It is getting the person on the other end to change their behavior that is difficult," McCoy says. "No one has said they won't do it, but they are dragging their feet. They are used to the fax machine."

There is one piece of technology McCoy would like to have: a vendor-agnostic piece of software that would "push" relevant data back to the practice from contracted physicians. The set-up would resemble a private health information exchange, with data from the contracted offices being delivered to a central repository operated by Metropolitan. McCoy is just beginning to investigate vendors that could deliver such technology, with DB Motion among the candidates. He'd like some text mining capability built into the system, so he could more easily scour text narratives for critical data not captured in a discrete format.

The group is currently trying out one natural language processing vendor to mine data from "long rambling dictations" produced by physicians. "We need to pull out the diagnosis and we need to mine the data to see if the physician is ordering the right tests and noting all the diseases," McCoy says. "It would be like a chart review, which, without technology, requires a person paging through the notes and reading everything. You can't hire enough medical directors to do this."

The text mining tool could even be used in capacity with his own physicians who dictate most of their notes on the eClinicalWorks platform (which also has the capacity to capture structured, discrete data). McCoy says that the potential of EHR is promising, but that the industry needs more mandated cooperation for it to take hold. "We are just scratching the surface about using technology most effectively for patients," he says. "The way I'll get cooperation more quickly is some sort of stick. If the government says to providers, 'under these circumstances, with the right security and business relationships, with the right documents, you must cooperate,' it would happen. Ethically, it's the right thing to do. The ability to coordinate care and keep people out of the emergency room would increase dramatically."

Charlie Santangelo
Vice President and Chief Financial Officer
Susquehanna Health, Williamsport, Pa.
Wish List Items: CPOE, Registration Scorecard

CFO Charlie Santangelo has one overriding wish when it comes to IT "We need information systems to help lower the unit cost of departments throughout the organization," he says. Operating efficiency is tops on his mind. Susquehanna's four hospitals generate some $500 million in total revenue, but Santangelo says the costs associated with earning that revenue can be driven down. His mantra: "perfect billing," an ideal state in which physician work is captured accurately at the get-go and then billed appropriately-without reworking rejected claims.

Toward that ideal, Santangelo would like to see an expansion of the health system's CPOE system, from Siemens, as the first step. Susquehanna is currently using electronic order entry on the inpatient side of the house, with nearly 90 percent of related orders entered electronically by physicians. "We need CPOE on the outpatient side," he says. The health system is in the process of building out the system for its 150 employed physicians, and Santangelo says it will come online in 2013. At the same time, the health system is expanding its Siemens financial system, which offers an integrated billing module.

In the integrated model, physician orders from the clinic or for outpatient services such as lab would draw on data from a master patient index, which includes insurance and demographic information. The system connects to payers, who in turn verify electronically if a given test is covered. "If it appears a test isn't covered, we can show the patient they may be responsible," Santangelo says. An all-electronic transaction would reduce the cost of the department offering the affected service, he adds. Processing orders that originate in paper requires rekeying. Ordering tests electronically "may add a little more cost to the practice but lowers the cost on the back-end and more importantly it reduces the chance of errors," he says. Currently many orders are billed without a preliminary diagnosis, a missing piece of information the integrated order entry/billing system would catch.