May 06 : Where does finance fit into EHR adoption, meaningful use?

One-third of the triple aim focuses on reducing the cost of healthcare, and the adoption of EHR and health IT systems has a major role to play in achieving that and the other two-thirds of aims by providing an infrastructure for quality improvement and efficiency.

Whether it is called an electronic health or medical record, the emphasis remains on the clinical and technical sides of the healthcare organization. However, the benefits of EHR adoption are not limited to clinicians and health information managers. The finance department also has a stake in translating these data into actionable information.

As the CFO and SVP of Finance for South Nassau, Mark Bogen, CPA, is tasked with managing the Long Island hospital’s financial operations, but during the shift from volume to value and incentives for implementing certified EHR technology, he cannot afford to be siloed off from other departments in the organization.

In this interview with EHRIntelligence.com, Bogen explains how meaningful use and other quality improvement initiatives have required him to engage with clinicians and informaticists more frequently and develop a working knowledge of the clinical and technological aspects of his organization for the financial good of the hospital.

In most organizations in the old, old days before the position of the CIO took root, many times the director of information services tended to report to the CFO because substantially the only real computerized gimmickry was the billing aspect — preparing the financial statements, running payroll and accounts payable. Nowadays, you wouldn’t leave it under finance person because then all they would care about are the financial components to technology and would forgo investing in anything that the clinical folks really needed.

I don’t think it really matters anymore because as we all realize, everything is so intertwined that whether my CIO reports to me directly or not never really mattered to me. I’m with him almost daily, and I’m also with my CNO and CMO daily. We’re all crossing lines here. You can’t afford to be just a subject-matter expert in something here. You have to understand everything that goes on. I’m never going to be able to appreciate all the intricacies from a clinical standpoint or an IT/techie perspective, but if I don’t have a reasonable working knowledge, then I can’t do my job effectively.

Obviously high up is meaningful use. We had calculated that we would be eligible for somewhere between $10 million and $11 million dollars in meaningful use monies over the course of 4 to 5 years. That certainly is a high priority for me.

I’m not a clinical person and I’m not a coding person, so I try to stay out of their way in terms of their needs. For me, though, the biggest need (and to some degree where the biggest arguments are) is the data. When I talk to physicians and anybody else who’s had their workflow substantially impacted negatively as a result of installing an EMR — whether it’s in the hospital, one of our outpatient locations, or a community-based office environment — the biggest complaint is that the lives of doctors are totally disrupted and that they don’t get to see the benefit yet of what all this money is being spent on and all this disruption is being created for.

For me, it’s about the data and analytics, getting them information in real time so that not only can they impact on the future of providing healthcare to the community but also they can actually in some cases impact on the patients who are in the hospital, offices, or clinics today. That is also driving me in terms of the wants, needs, and results of having an electronic medical record infrastructure.

I’ve been in the business for more than 35, almost 40, years. When I first entered the business in the seventies, when someone threw the term “quality” around it always seemed to translate into higher costs, more expensive. It’s almost like a nurse in every pot. It was always things associated with adding to cost that didn’t necessarily produce anything that drops to the bottom line.

After spending all these years in the business, I truly have to some degree become a convert and believe that higher quality will ultimately lead to less cost. But it is still too often intuitive and not enough where I can show myself, the organization, and the clinicians that in fact is the case. It’s not only accumulating the appropriate clinical information, but it’s also the marrying of that clinical information with the financial outcomes to demonstrate that the harder we push the better quality and outcomes we will have. From a clinical perspective, overall the reduction in the variability of care will lead to lower cost per case.

It’s so fascinating to get to watch some of these clinicians who are now getting data at their fingertips in real-time as opposed to having to wait six months or more for a series of paper medical records to be reviewed. You’re talking six to nine months after the fact, so you lose all that valuable time and actually making an impact.

Now, it’s a couple days to a week, but the instantaneousness of getting data to someone who now knows what to do with it has been fascinating for me to see evolve. But we’re still in our infancy when it comes to analytics in general and still in the womb as it relates to the ability to marry the clinical component to the financial component. We understand that this is going to be an ever-evolving, continuous, never-getting-to-nirvana kind of journey, but we’re at the very beginning of the yellow brick road.