HIStalk Interviews Marc Probst, VP/CIO, Intermountain Healthcare

Marc Probst is VP/CIO at Intermountain Healthcare of Salt Lake City, UT.

You have a history of speaking out about Meaningful Use. How has your opinion of it changed over the last several years?

Meaningful Use came out as a stimulus package. Did it stimulate the economy and health IT? It clearly did. If that was the plan, it was successful. Did it get more EHRs in physicians’ offices and in hospitals? It clearly did.

Did it move healthcare dramatically to lower costs, or even incrementally, to lower costs and higher quality? It has not. It has a long way to go, and because of the way we approached it, with check-the-box certification and achievement of Meaningful Use, it just didn’t deal with the underlying challenges of things like standards of interoperability.

The last point on that is simply how much money we’ve spent for the value that we’ve gotten. It’s minimal. All along, I felt we should have dealt with that and that’s why I’ve been so outspoken, a thorn, probably, in the side of my colleagues at ONC.

What was your reaction to Andy Slavitt’s remarks at the JP Morgan Health Care Conference, and then in the follow-up CMS blog?

On one hand, it’s disappointing because we’d like to see the end of Meaningful Use. I don’t speak for every CIO, but the ones I know were kind of excited to see it end. It wasn’t achieving necessarily all the objectives we want to achieve, so that was the negative.

The good side is that the national conversations picked up around what is the value of Meaningful Use and how the program should be changed to become more effective. I think that’s positive. The water under the bridge is how much money we’ve spent and the steps we’ve taken to this point.

The optimist in me things we’re going to have a good conversation about it. We’re going to talk a lot more about outcomes and how organizations can achieve outcomes that are better with technology. If properly done, properly incentivized by the government or not disincentivized by penalties, I think we can make some really important strides.

How would you like to see Meaningful Use transition into something truly beneficial?

I’d like to see it become outcomes-driven. If I can prove to you that I have lowered the incidence of diabetes or some of the clinical outcomes that are associated with diabetes because I’ve used information systems and data to do that, that’s a good thing. It lowers cost for the country and improves healthcare.

If we can do that with diabetes, let’s go to heart disease. Let’s go to incidence of jaundice in or around birth. There’s so many areas we could focus on, and if we turned it to that direction, you’re going to have clinicians and technologists working together to leverage these tools we’ve put in place to improve care and lower cost.

That ought to be our outcome, not whether or not we placed 60 or 90 percent of our orders through CPOE. If we can shift that conversation and then the incentives around that, I can just see massive innovation and much more benefit come out of these systems.

Intermountain is just over two years into its contract with Cerner. How is the partnership going?

It’s going very well. I think like every other organization, our very first go-live was a learning experience. Having to help physicians and other clinicians understand how to use the system was a tad painful. It wasn’t easy. We were Intermountain Healthcare. We thought we knew everything, but we had a few things we had to learn.

We did that last March. We went live with our first two facilities on clinical and rev cycle. That was two hospitals and about 20 clinics. Then we went live in late October with two more hospitals much larger in size, one of them our second-largest hospital.

Then probably 60 more clinics and rev cycle and everything surrounding it. That one went much better because we had learned so much from our first implementation and we’re now ready to go much more quickly. We’re going to probably bring up probably 12 to 15 more hospitals in 2016. We know how to do it better now, so I would say it’s going very well.

If you had to pinpoint one lesson learned that you’d like to share with other CIOs and IT teams, what would that be?

Adequate resources on the clinical side to help physicians adopt their work flows, without a doubt. It wasn’t technical issues. Technically, this thing went swimmingly. It’s all around adoption, use of the system, and changing work flows.

Did you bring in any consultants to help with those initial implementations?

The second one we did. The first one we did all on our own with Cerner’s help. The second one we brought in Leidos, primarily, to really help us get it done. They were very, very helpful. We’ll use them going forward.

What’s the biggest lesson you think your end users have learned or are in the process of learning?

Just how involved they have to be. You must have leadership on all levels. We’re divided into regions and then those regions have multiple facilities in them. That local leadership has to participate. This isn’t something that can be done to them. It has to be done with them. As they participate, our success rate goes way up.

What sort of ROI are you looking to get from your partnership with Cerner?

I don’t think any of us have fooled ourselves into thinking it’s going to be cheaper than our self-developed systems. What we’re getting with Cerner is a much more comprehensive solution. That’s been really positive.

Given that we’ve built systems very unique to the needs of Intermountain, our concern in transitioning to a system we didn’t build was, would we be able to retain that level of … I hate to use the word interoperability … tightness between what we’re doing from data analytics and what we’re trying to do from a process and workflow perspective to obtain those levels of best practice care and cost that Intermountain is known for. It’s actually what drove us to Cerner, because we thought we had a much better chance of doing it with them than we might with one of their competitors.

To date, that’s become much less of a concern. We’ve achieved a lot. We’ve done a lot of work in enhancing the core Cerner model system to have more of those capabilities, so I think our ROI is with this more comprehensive system and the greater amount of data that it provides.

We can go to the next level of best practice care. We don’t think we’ve gotten there. We think we can build in a lot more activity-based procedures and cost mechanisms so that we can even better understand where we’re spending money and where we can lower our costs and improve our quality. That’s really been our focus and that’s where we see the ROI.

The expense of doing something like this … did we lower IS costs or workforce costs? We haven’t really focused on that and we won’t. We know the benefit comes from providing better care and doing it at a cost that’s lower than what we’re doing today.

What is Intermountain looking to accomplish from a population health management standpoint this year?

We’re building a digital health strategy, and so this year we’ll be looking at how to engage patients with portals, mobile, that kind of thing. We’re really building out the strategy on how to do that. To suggest in 2016 we’ll accomplish a ton, I don’t think so. We’re just getting our ducks in a row this year as to how we’ll pull it off.

However, from the data side, we’re looking at understanding where our opportunities are around population health. How do we get to value-based payment and how do we contract with physicians that are going to be moving to population health and value-based care? We’re working with Cerner with HealtheIntent to support that exercise, but we’re also depending upon our legacy electronic data warehouse and traditional analytics.

What will you be looking at on the HIMSS show floor this year?

Security’s going to be a big issue. In fact, I just got out of a meeting to have this call, an all-day meeting that’s got some big players in town talking security.

Also, I think anything around population health and more visible things like portals, mobile, and wearables, that kind of thing. That’ll be pretty interesting to me.

Plus, I’m looking forward to connecting with old friends. I’ve been in the industry a long time and it’s a pretty small one, all things considered. It’s a great industry.