Bruce Smith serves as senior vice president of information systems and chief information officer at Downers Grove, Ill.-based Advocate Health Care. He's been with Advocate for more than 20 years, previously serving as chief information officer for Advocate Lutheran General Health System. Modern Healthcare reporter Joseph Conn recently spoke with Smith about the challenges of having multiple electronic health-record systems in his organization, Advocate's readiness for the conversion to ICD-10 coding, and his views on federal interoperability and meaningful-use policies. This is an edited transcript.
Modern Healthcare: You've been with Advocate for quite some time. Why did you stay in one place for so long?
Bruce Smith: It's been like having 15 or 20 different jobs. I have worked for a half a dozen different CEOs, so it's changed continuously.
MH: Advocate has 12 hospitals and several physician groups including the Advocate Medical Group, Dreyer Medical Group and Advocate Physician Partners. Your hospitals have Cerner as the electronic health-record system. What about the physicians?
Smith: The Advocate Medical Group is using Allscripts. The Dreyer Medical Group is using Epic. And Advocate Physician Partners contracted with ECW to provide software for those independent physicians that wanted an EHR.
MH: How do you keep up with all of that?
Smith: There's an advantage if you have everybody on one platform. But there were political reasons why we got to this state of multiple platforms. When we were putting Cerner in the inpatient arena, its ambulatory product was not as strong as it is now. So when the Advocate Medical Group was looking at systems, they decided to go with Allscripts.
When Advocate Physician Partners was looking for software, a lot of those physicians were independent. They did not want to be on a centralized EHR. They also wanted an EHR they could have more control over, so if they decided to leave Advocate they would have some ability to take their EHR with them. So they agreed to the common platform of ECW, but they wanted the independence of staying separate. All this has created some challenges for us.
MH: HHS' Office of the National Coordinator for Health Information Technology in January released its interoperability roadmap with a goal of national interoperability for a core data set by the end of 2017. Do you think that's the right way to go and is it doable?
Smith: It's a reasonable step to move in that direction. The one institution that has obtained pretty good interoperability is our banking system. In some ways, it may not be as complicated as healthcare. But they have a common set of transactions that go through a central banking facility and then are transferred to others. So there are rules of formatting and content that you have to play by. Individual banks aren't told what software they have to use, but they have rules about how to play on the highway.
This is what the ONC is starting to move toward in healthcare and it makes a lot of sense. You don't solve the whole thing on Day One. You start building a standard set of transactions, which you require in order to play in the central system, then the central system can move that data around with everybody who is playing in that same format.
MH: Is Advocate going to be able to comply?
Smith: I think we'll be fine. We've worked with Harris Corp. and built a layer of software over our products so we can give a unified view of a patient across Advocate that's got information in Allscripts and Cerner and ECW and home health. We can display that information in a central view. We've written some of that software. We're also a member of the Metropolitan Chicago Healthcare Council, so we have some standard formats to play in that arena.
MH: Do you have a central warehouse for data?
Smith: No, we stayed away from that. It creates all kinds of other issues in terms of duplication, added expense, the difficulty of security and keeping the databases in sync. We go into those databases, pull the data out and display it.
MH: What's your take on the new CMS rules for Stage 3 meaningful use and the new ONC rule for vendors to meet the 2015 edition?
Smith: If we look at the requirements for Stage 1 and then Stage 2, and now what we're seeing in Stage 3, they're moving along a pretty consistent, deliberate path of what they want to see. We're in the full year of complying with Stage 2 in order to meet the requirements. Next for us will be Stage 3.
But it looks like Stage 3 is going along that same pathway of more interoperability, more integration with the patient, being able to work with exchanges and public registries and more coordination of care between different entities and providers. It's getting tougher at every stage, but they don't seem to be taking right turns.
MH: What's going to be the hardest meaningful-use hurdle?
Smith: Patient access to electronic records provides some challenge for us simply because we've got such a varied base of patients. Some patients are very tech-savvy, have personal computers and access our portal. Other patients don't have a computer. So your base of people, in terms of how they want to interact with the health system, is quite varied. The CMS might want to say, “We want everybody to be able to do it this certain way.” But they can't really dictate to the patient population.
MH: What are other tough IT challenges?
Smith: We have a proliferation of technologies bombarding us. At the Healthcare Information and Management Systems Society convention, there were hundreds of vendors that have new technologies directed at healthcare. Many of these look very intriguing.
But so many of these technologies are very niche- oriented. How do you bring all these vendors in and put this in an environment where your information and processes flow together?
MH: Is Advocate ready for the Oct. 1 conversion to the ICD-10 coding system?
Smith: We took it very seriously last year, and we made a lot of changes and did a lot of education. There are a number of people who think it won't happen, which I think is possible. But we don't have a choice to ignore it. So we picked up where we left off last year—education and training of our physicians and our coders and getting our software in place. Our feeling is, if it goes live Oct. 1, we're pretty ready to deal with it. If it's delayed again, we'll accept that and then we'll move with whatever course of action is presented.
MH: Have the giant data breaches around the country had any effect on Advocate's approach to security?
Smith: We had our experience with some issues and that does have a big impact on you. If you had asked me, “What's your nightmare?” certainly having your systems breached is No. 1 or 2 on the list. It's something that you can never just go home at night and say, “I know it won't happen.”
Our systems are being pinged every day, thousands of times. We're well aware of the danger. And you see things that happen against companies that we know have great security and have very bright people working on it. We think we have good programs but you can never feel 100% safe.