Chip Hart is director of pediatric solutions at Vermont-based Physician’s Computer Co. (PCC), which provides a range of healthcare IT services including EHR implementations, patient portals, pediatric dashboards and benchmarking, and HIE registries. The company focuses heavily on independent pediatric practices of all sizes. Hart has been with the company for nearly 25 years, and helped PCC develop its own EHR four years ago.
What are the biggest IT challenges facing pediatric practices today?
The speed of the market and not knowing who to align with. Should I sign with this ACO (um, no probably not), should I take the hospital’s EHR subsidy (maybe), will the cloud-based EHR I use today be with me in two years (maybe)? Let’s face it: Pediatricians are an afterthought in every major healthcare system and decision process (Meaningful Use is a joke; PCMH is awkward at best; and ACOs don’t get it), so pediatricians are trying to predict the future right now, and that’s difficult.
Clinical integration is going to be the game changer, just as it has always been. Ideally, we’ll have a market where any practice can choose an interface that suits them best and their data will be shared with those who need it.
How have you seen IT impact – positively and negatively – these kinds of practices?
On the positive side, I’ve seen more and more practices get pulled into the EHR world and found that it’s not so bad on the other side, if they have the right friends. I’ve seen some amazing clinical improvements as the result of simple IT change. Leveraging IT to improve preventive care and chronic disease management is a giant gain in my experience.
On the downside, we’ve seen clients get aligned with vendors with predatory data control – vendors who make conversions impossible or impractical. The big downside that all the vendors understand is that MU has killed EHR development for the last two years and will continue to do so for another two. Even if we end up ahead, quality-wise, we definitely gave up innovation.
Based on recent reorganization, funding reduction, and high-level employees moving on, do you think the ONC and its MU program will remain relevant in the next three to five years?
It will end up being a bastardized version of the bastardized thing that it already is. One party has threatened to pop that balloon the moment they get that chance. If they win the next election, are they going to follow through on the threat? I’m not sure either party has the discipline to stop the payouts (especially the Medicaid adjustments these last two years).
How do you think ONC’s 10-year vision for interoperability will play out, particularly as it relates to pediatric practices?
I was just telling someone that I couldn’t imagine having the conversations we have today pre-MU. Although the interoperability requirements of MU strain credulity at times, the fact is that the entire industry really is talking about sharing and exchanging data in a very new and different way right now. We, the vendors, all know it’s possible but it requires a will to make it happen. Data exchange is 10-percent competence, 10-percent technical, and 80-percent politics. I think we are in a better place as it relates to interoperability, and MU has had a positive impact.
Ultimately, the portability of a practice’s data will be the most important consideration over the next 10 years. Even if you have the right HIT partners, you may no longer have the right business partners and will need to move sideways. A significant portion of our new clients are born from practice divorces (and I guarantee that the practices who’ve sold out to the hospitals will be back soon enough … just like last time). Not losing that data is vital.
What will be the big focus for pediatric practices once MU has been met? Will they begin to focus their time on establishing interoperability to better participate in ACOs or patient-centered medical homes?
PCMH, no question. I actually wrote a blog about this two months ago. I’ve yet to see an ACO offer or model that makes any sense for pediatricians (heck, I don’t think they make much sense for almost any independent practice). The fact is that ACOs need pediatricians in their panels for accreditation or whatever, but pediatricians don’t need them. Meanwhile, we have dozens of Level 3 PCMH practices who have recognized huge financial improvements, a big multiple over the MU money. In some states, it’s worth $50K+ per doctor, which is huge for a pediatrician.