HIStalk Interviews Adam Cheriff, MD, CMIO, Weill Cornell Physicians

Adam Cheriff, MD, is chief medical information officer of Weill Cornell Physicians of New York, NY.

Tell me about yourself and the organization.

I am the chief medical information officer for Weill Cornell Physicians. I’m a part-time internist, the rest of the time responsible for the clinical health information technology and clinical operations for our physician organization. Weill Cornell Physicians is 950 multi-specialty faculty physicians associated with New York-Presbyterian Hospital.

You recently went live with Epic. How’s that going and what are the most important lessons that you’ve learned so far?

We have been an Epic ambulatory customer for many, many years, since 2001. We have a great deal of experience with ambulatory clinicals. What we did most recently was convert our legacy practice management system, which had been GE-IDX, to Epic. We’re very happy with how that’s gone.

We gave it a lot of careful consideration as to what the motivations were for doing it. For us, it was really about trying to consolidate onto a single platform for our administrative and clinical systems; the patient experience and improving it via self service; and lowering the training burden for our staff and faculty. We had an eye towards the future, where we knew we were going to have to do more advanced analytics, and being able to seamlessly move between the clinical and the administrative was a big deal. We had a hope that in doing this that we would lower some of our long-term operating costs.

We went into it with what we thought was good justification. I thought we were thoughtful in terms of how we restructured organizationally from an administrative business unit standpoint in order to support the implementation. That really was a lot of matrixing of the IT and clinical staff that knew the Epic clinicals and knew how to manage that relationship, the business office that were the core revenue cycle domain experts, and our finance office. I think that matrixing really helped a great deal.

Some organizations, particularly on the hospital side, have struggled with the conversion to Epic from a revenue cycle standpoint. What’s been your impact?

We feel very fortunate, obviously. I think the press seems to have a little bit of a selection bias in terms of seizing on, unfortunately, the missteps. I can completely see how these things would happen. They’re extremely complicated projects.

We have felt very, very fortunate about how things have gone. I should say that our implementation methodology may have predicted some of our success. Despite the fact that Epic would like to see organizations do this big bang — and I think that there are reasons for that in terms of not necessarily bleeding this out and being trapped in two worlds — we did this in a series of pilots leading up into a big bang. That gave us just enough experience with the new tools, so that with each phase of it, we got stronger.

The high-level summary of our financials is that for one cohort, we’re about six months into this. For the two-thirds of our business, we’re about three months, or one quarter, into this. We are 10 percent year to date increased in our receipts. Now it’s unfair to attribute that all to Epic, because obviously we have a lot of other growth initiatives. But if you look at it from the standpoint of what we budgeted in terms of anticipating that growth, we’re still three percent up, which you can fairly attribute to the Epic effect.

The main efficiencies that we’ve gained is that Epic is great in terms of transparency and accountability, for working charge edits and claim edits, and really has a great task management system to do that. Our pre-AR, we’re working much more aggressively than we were pre-Epic.

When you converged onto the single Epic platform, what goals and metrics did you hope for as an outcome?

We looked at the classic revenue cycle metrics. Those are all important. Days in AR , and this might be somewhat Epic-speak, but days in pre-AR as well, claim edits, denials.

Epic does a fairly good job of being prescribed and doing a fair bit of hand-holding with tools to be able to look at those metrics as you’re making the transition, even including some of the legacy practice management statistics as you make that implementation. We are also very interested not exclusively in the revenue cycle side, but also on the access and front-end side — registration quality, patient duplicates, the number of patients that make online appointments, our access metrics in terms of how long people have to wait to get appointments, and so forth.

When you mentioned patient self-service, were you primarily referring to self-scheduling?

Yes. Self-scheduling and online bill payment were the two features of MyChart that we were able to unlock with the conversion to practice management.

What kind of feedback do you get from patients?

It’s a little early for us to have amassed a lot of formal feedback. Anecdotally, we think that patients love it and that it is definitely helping our brand. Although I will say that given our marketplace in New York City, we have to keep up in that. Many of the other big academic centers are using similar if not identical platforms. Patients really like the convenience that is afforded in sectors other than healthcare. 

Culturally, from a physician organization standpoint, we still have a ways to go. While the consumer is definitely demanding it and the patients want it, the physicians are a little bit slow and guarded about the degree to which they’ll give open access to scheduling. But I think we will evolve.

You mentioned that Epic is part of your brand just as it was for Kaiser Permanente, who named their implementation HealthConnect. Do you see that as a competitive advantage and a way to enhance your brand with patients?

Yes. We did something similar right down to the name in that we branded MyChart as Weill Cornell Connect. The patient engagement strategy is so important. From a regulatory standpoint, it’s become increasingly important in terms of all the Meaningful Use objectives around engagement and how you need to communicate with the patient.

From a branding standpoint, the patients really do feel connected. Part of it is the transparency and the visibility of the record, which, of course is something else that the physicians slowly have to wrap their heads around.

But it’s really the interactivity. It’s the ability to, in an asynchronous way, reach out to the practice for all the things that people need to reach the office for. Not being on these endless phone queues is a real patient satisfier.

You mentioned that having both sides of the house on Epic gives you some new opportunities. What are you doing or what will you be doing in terms of analytics and population health management?

We are pretty energized about this. Clearly we’re moving from the phase where it’s less about the adoption of the technology, even to some extent less about optimization, although that is going to occur forever. It’s more about now that we have had critical massive adoption, what do we do with all this great data that we have been collecting? We, like most Epic clients, rely heavily on the relational model of Epic’s data, which is Clarity. We have pretty sophisticated report writers and business intelligence tools, including both Business Objects and Cognos, that sit on top of that. 

We are very eager to see where Epic continues to develop in this arena. They have done a good job of recognizing that in order for us to effectively manage populations, we’re going to need more than just the data that’s within Epic. The Epic data warehouse that they’re building towards that will allow us to take in outside claims data and patient satisfaction data is very intriguing to us.

Have you gained insights from having all that data available?

We engage in the same kinds of clinical outcomes and chronic disease management metrics that most large institutions engage in. We understand how our diabetics are being managed and our CHF patients and COPD and the chronic disease markers. 

We have struggled, like many organizations, to drill into that from a utilization and cost containment standpoint. That’s why it will be critical for us to start to marry those clinical data, which have become ubiquitous in our system, with the claims data that will be generating now that we have the practice management system.

How do you see practices changing both in terms of the changes prescribed by the healthcare environment and the availability of the technology like you’ve implemented?

Oh, boy, that’s a good one. The technology absolutely changes our culture and our practice patterns. I can give concrete examples over our life cycle. 

The first thing that the electronic health record did is it made us function more as a group model. We are a group. We’re a federated group of clinical departments. But sharing the single patient record with the focus changing from the provider’s record to the patient’s record was a real paradigm shift in the way that you can’t help but promote communication. That has promoted better outcomes. 

The next major paradigm shift was the rise of the patient portal, that level of transparency and really getting providers to understand that in many ways the patient owns the data and being as transparent with the results. The self-service model and the online scheduling. Even the rumblings of the OpenNotes project, where people will expose their clinical documentation. 

These are all things that are going to be profound drivers of the way we practice and probably will predict better outcomes because you’ll have a class of patients that’s much more engaged in their care.

Are you implementing more evidence-based medicine and standardized care protocols along the way?

We have. We have made use of fairly standard decision support tools that are available in Epic, particularly around Health Maintenance Rules. For certain populations of patients or certain chronic diseases, making sure that we have the data-driven schedule of what should be done for those patients. We use decision support alerts to support that. I think it’s been very effective, actually. We probably have, at this point, dozens of rules that are keeping track of that information.

Is there more interest, or could there be more interest, in patients taking a more active role in their healthcare and their health than they have previously?

Yes, because it’s more accessible. If you go back even just a few years pre-portal, it’s pretty difficult for patients to really access their information. What they’re left with is what they can absorb in a hurried clinical interaction, which is often exceedingly difficult for patients. As the word says, a portal is a window into what’s going on with them. 

The fact that we’ve been able to embed patient-friendly education that directs people to do further learning about their conditions, I really do. Where Epic is developing some of the tools that we’ve implemented is that for chronic diseases, that there are tools for patients to engage. Whether that’s blood glucose monitoring for the diabetic or blood pressure monitoring for the hypertensive, that’s a way for them to engage in their health and to promote that communication back with the provider.

If you look ahead two or three years, where do you see the most important IT-related priorities that will impact your organization?

It may have become a cliché at this point, but the past couple of years have really been about keeping up with regulation. Unfortunately I don’t see that necessarily dying down. Meaningful Use, ICD-10, and all these things that we really have to do. A lot of good that has come out of it, but in many ways, it has stifled innovation. 

The next couple of years are going to be about usability and trying to refine these user interfaces. Clearly interoperability is where we’re headed. The goals of some of this regulation is consistent with promoting the this interoperability, but many of us at the ground level have not seen that realized. T think that’s going to be incredibly important.

Locally, and this is true of many organizations like us, growth is going to be a big driver. The fact that we’re probably going to extend into a larger provider network to take care of larger populations, we’re going to have to find ways to spread our technology and to be reasonably agile about that.