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Editor's note: This Visions interview with Bill Petasnick, chief executive officer of Froedtert Hospital in Milwaukee, is part of a series of healthcare IT articles that will be published in advance of WTN Media's annual Digital Healthcare Conference. The conference will be held May 7 and 8 in the Fluno Center on the University of Wisconsin-Madison campus.Petasnick has been CEO of Froedtert Hospital since 1993, and is chairman of the American Hospital Association. The Sheboygan native has led Froedtert through a massive multi-year process of implementing Epic Systems' electronic medical record systems in its outpatient settings (72 clinics), and certain elements of it - pharmacy, scheduling, and registration - in the hospital setting. Froedtert has invested more than $60 million these systems, giving Petasnick a well-developed perspective on the value of healthcare IT.WTN
: Healthcare costs consume about 16 percent of GDP with estimates of over 25 percent as the population ages in the next decade, which some believe is unsustainable. Do you think healthcare information technology adoption, in itself, is a panacea for those rising costs, or do you think we need systemic changes as well?
: I think it's multi-dimensional. I've been one who has advocated change because I think it's a whole variety of things. IT right now will improve healthcare in some ways, but the bigger issue in IT is that we've got to get to greater interoperability to really create some of the economies of scale that are needed. That requires a higher degree of collaboration among manufacturers. It may take the federal government to get involved in the standard setting, but I think at this point IT offers a promise. The cost of IT is incredibly expensive.
I'm talking about interoperability among a whole series of different vendors out there. There is not consistency in terms of platforms, so we may invest millions of dollars in a clinical electronic medical record, but the patient is also involved.
A part of their care is that in another institution, their health information may not ordinarily transfer because of the interoperability problems.
We've got costly administrative overhead because, again, we're dealing with multiple billing system requirements. There is a lot of backroom cost associated with that in terms of a multiplicity of different kinds of regulatory oversight requirements, and they are not consistent. One payer may want a set of work forms that may be different from another. All those types of things come into play.WTN
: Since you support systemic change, do you have a preference for the kind of healthcare system we should have. Perhaps a public-private system like the Democratic presidential candidates propose? Petasnick
: My own view has been is that the history of this country is a pluralistic healthcare system, which is the blending of private and public. I certainly would support that. I think a key element also is that as we try to move forward on a broad reform agenda, it requires lifestyle changes. By that, I mean a lot of things that we see today in our institutions' ERs and hospitals are associated with the lack of a focus on wellness. As a result, poor habits generate significant needs, and growing obesity problems have resulted in an increase in diabetic problems and other types of things as a result of poor lifestyles. So that has to be addressed. There has to be the appropriate incentives on that side.
There does need to be a greater focus and adherence to evidence-based medicine. I think we're making good strides in that, but it's still an area of continued focus. WTN
: Do you still do quite a bit of optimization after the implementation of an EMR component?Petasnick
: Oh, quite a bit. These are very complicated systems to operate. They are costly to operate and costly to maintain. They require a tremendous amount of training and adjustment. I think you implement these with the idea that you're going to get some cost savings. I think that has yet to be seen, but in terms of internal efficiencies, you'll certainly see those in terms of improved efficiency and access to information. It's positive. WTN
: Let's talk about the integration issues associated with your efforts to consolidate with Columbia St. Mary's and St. Joe's in Progressive Health. How does that impact the pace of IT adoption when you have integration issues with other facilities? Petasnick
: I think that's our challenge. I think we see the opportunities with regard to clinical integration, and IT is a big component of it. We're hoping to achieve efficiencies and economies of scale as we implement these. Our challenge gets back to interoperability. We've made huge investments in one particular system called Epic. As a matter of fact, Columbia-St. Mary's over the years has made huge investments in another system called Cerner
. The challenge we have is to figure out strategies to get these systems to connect to each other. I think that, again, is sort of symptomatic of why interoperability is such a critical issue in healthcare. WTN
: What do think of the incremental approach to patient data exchange that's taking place in southeastern Wisconsin through the Wisconsin Health Information Exchange
: I think they are being cautious because of the complexity of what we're dealing with, and it's going to take time to do it. The ED [Emergency Department] Linking
system is still in the pilot stage and I think so far the pilots are reporting that this information has been very helpful, it allows more effective coordination of care, and we need these. It's a good starting point. WTN
: Do you have any thoughts about the current RHIO
(Regional Health Information Organization) model? Some are failing nationally. Do you believe they can work, or should it be replaced by something that has economic incentives for all the players involved?Petasnick
: I think conceptually, it's a model that has yet to be proven. Coordination, even when you're all economically aligned, is complicated because, again, these issues of standardization and interoperability are the keys to this process. I think the RHIO concept has a long way to go yet. Right now, many of these are being done, even in our own area here, without leadership that is tied to the particular health systems. WTN
: You've talked about some of the benefits of healthcare IT. Is there anything that concerns you about it?Petasnick
: In addition to the cost? WNT
: Yes. Perhaps expectations not being met?Petasnick
: I think we're all on a learning curve in this area. The systems are only as good as the people who are available to maintain them, and the ability to train people and refine these systems. There are growing shortages of highly skilled people in this area. It's one of our greatest limitations. The deal is whether or not there are enough highly skilled, trained people that can effectively operate these very complicated systems. These are not turnkey systems. They require a fair amount of modification and customization of templates, and they are timely and complicated to install and maintain.WTN
: As the current chairman of the American Hospital Association, what do you want the AHA to be communicating to its members regarding healthcare information technology adoption, and is part of the message going to be about the importance of linking that adoption to clinical or business process improvement?Petasnick
: Our strategy is very focused. When you look at health reform, information is key. You can't have good care coordination unless you have good information, so we view it as a priority. We view interoperability as a priority. We also feel that there needs to be a better way, a mechanism that needs to be developed to provide for some financing. We've got 5,000 hospitals in this country, and a significant portion don't have the financial wherewithal to acquire some of the information systems that we're talking about.
With our system alone, by the time we bring up Epic, we could be spending close to $60 or $70 million. There aren't a lot of institutions that have that kind of capability, so one of our concerns is that there needs to be a financing mechanism developed that would enable a lot of the smaller institutions in this country to have access to grant funds or some other things that would enable it.
We've also got to push this interoperability issue. We see the importance in our agenda. If you go to our website and look for our Health for Life Initiative, it's built around care coordination. You can't have effective care coordination without good data. WTN
: Are there enough hospital executives that are aware of the link between healthcare IT and business and/or clinical process transformation?Petasnick
: Oh, absolutely. WTN
: That's no longer an issue?Petasnick