Advocate Health Care's Technology Plans for the Long Run

How are healthcare CIOs preparing for the possibility of the federal government going over the fiscal cliff? I spoke last week with Bruce Smith, CIO of Advocate Health Care, the largest integrated healthcare system in Illinois, about the post-election landscape.

"We've got strong cost management processes in place," he says. "Actually, we put those in place regardless of the fiscal cliff. We're making the assumption going down the road—if you look at where Washington's at and what's coming out there—there are going to be reductions in healthcare spending, so we know there's a good possibility that we are going to be under more economic pressure."

Chicago-based Advocate is big, with more than 250 sites of care, 10 acute-care hospitals, and a children's hospital with two campuses. In the grand scheme of things, the recent election was barely a blip on a six-year-old mission to build electronic medical records and digitize as much clinical information as possible to make it available anywhere, anytime.

"There were probably a few things that we altered in terms of the quality indicators," Smith says. "We changed some processes to collect that information, and maybe a couple of other access things, but for the most part I think we were pretty much on track with what came out of Meaningful Use."

Not that Smith ignores what's going on in Washington—far from it. "Probably the big things that will impact us coming up in the next couple of years will be the development and the maturity of the ACO process, and then of course what's going to happen when the [health insurance] exchanges come into play," he says.

One year into Advocate's ACO agreement with Blue Cross Blue Shield of Illinois, "We saw costs go down, so it benefitted both Blue Cross and Advocate, and I think there's further discussion now about how to make that product and that process even more effective in the coming years," Smith says. Advocate also joined the Medicare Shared Savings Program in May.

All inpatient hospitals run Cerner electronic medical record software out of a data center based in Kansas City. For outpatients, the Advocate Medical Group runs Allscripts. Advocate Physician Partners, which coordinates care between Advocate Health Care and more than 2,000 physicians on the medical staffs of Advocate hospitals, is deploying eClinicalWorks. That's right—three EMRs.

"I know you might ask the question, Why would you do that?" Smith says. "What it does is it gives our independent physicians the option of staying independent. They select if they use the software [and] they work with the vendor. If they choose to leave Advocate Physician Partners, they can do so and take the data with them. It remains under their control, as opposed to the Medical Group, in which everything is in one shared database."

Advocate is also producing a Web layer over those three record systems. "Our Web layer product pulls the three of them together and displays the information to make it look like one common record," he says.

When I mention Meaningful Use Stage 2, Smith seems confident Advocate can hit the Meaningful Use Stage 2 adoption deadlines set by CMS for 2014, despite talk around the healthcare IT industry of vendors being unable to make it happen.

"We have some concern, although a lot of it's not necessarily the vendor, either. It's our own internal processes," Smith says. "It's like most things we do: If you plan it and you work hard at it, you can make it happen. So far, I will say our vendors have been very good. I think Cerner's been particularly good to work with. They've delivered on everything we've needed. The stuff they've delivered on has been good quality, so I'm pretty confident in that area.

"I probably have a little bit more concern about Allscripts. So we're just going to have to kind of see how that works out. But overall, we think we're positioned pretty well. When we look at what Washington's trying to do, which is trying to get the industry to get with the times and automate, I think it's very worthwhile, and we certainly appreciate all the money that we've gotten and what we're going to get through the Meaningful Use process."

Outsourcing its data center to another company saved Advocate $15 to $20 million in capital expense, and offered "significant savings both in capital and operating expense" over the ten-year period of the agreement, Smith says.

Smith saves his choicest words for ICD-10.

"It's a little bit like being a zebra in the herd that's being circled by lions," he says. "You know somebody's going to get eaten. You just hope it's not you. I guess that's kind of how we all look at ICD-10. It's something that probably needs to be done. Nobody wants to do it. The cost of doing it is extremely high. My guess is it's going to take the deadline to really flush the whole thing out. We do have processes in place now that are doing the planning for it.

"The big deal is going to be, How do you get your physician population educated enough to use the new coding. I think that really is where the real challenge is. If they delay it another year, that would be fine with me. If they don't and it's the law, then we're going to comply with it."

Smith foresees a "consultant frenzy" nearer to the ICD-10 conversion date, one that will rival similar scrambles during the Y2K and HIPAA transitions.

The impact of technology reaches all the way into the executive level at Advocate. "If you look at the members of the C-suite, I think probably they'd prefer to talk about building new hospitals and new wings and new buildings, because that's kind of what they've always done," he says. "But I think you're seeing more and more the understanding of the importance and the significance of the technology investments, so there's no question it gets much more attention at a much higher level than it ever did before."