Fierce exclusive interview - Atlantic Health's Linda Reed: Our focus should be on patient care, not project implementation

Linda Reed, vice president and chief information officer at New Jersey-based Atlantic Health, knows a thing or two about successful healthcare collaboration. As president of Jersey Health Connect, Reed helped organize an 18-hospital information exchange system geared toward improving patient care through real-time data exchange. Reed also recently earned fellow status from the College of Healthcare Information Management Executives.

FierceHealthIT talked with Reed about her thoughts on Meaningful Use, successful health information exchange, and what she views as most stressful in her line of work.

FierceHealthIT: You recently called Meaningful Use "yesterday's news" but also called the burnout from implementation a big problem. Explain why you think Meaningful Use is both easy to overlook, yet so burdensome that it's overwhelming for hospital executives.

Reed: I think it's because all of a sudden we're needed everywhere. If you look at our regular business, in the past, 70 percent of our projects typically were planned, and about 25 percent were things that came up randomly, so you had a little more control. Today, things just seem to pop up everywhere....Almost 50 percent of our projects are unplanned.

For example, we acquired a hospital that hadn't upgraded their systems, and had to bring them into the fold and replace all of their systems at the same time were were trying to do all of the other things [ICD-10, 5010]. At the same time...our data center ran out of space. I think almost everyone is in a similar boat, though. It's kind of like dominoes, right? You hit the first one and they all kind of fall. There's just no breathing room.  

FHIT: With so much more unplanned work, what ends up on the backburner?

Reed: Probably the attention we used to provide for support. We used to be able to provide more consumer support and we used to have more road mapping sessions. But for the last year we haven't been able to provide the kind of customer service that we're used to providing.

I talked to all of my peers and everybody is in the same boat. They're starting to see their staff just exhausted; they're starting to see some staff turnover because a lot of these folks are thinking 'is this level of activity going to stay?' And it might. 

FHIT: What are your thoughts on health information exchange?

Reed: I think adoption's a little slow only because right now it's so early that the value might be limited. It's kind of the same thing as when you lay down road. You need to have the infrastructure before you can provide the value. I think the issue right now for some of these places is 'how do I justify paying to become part of something like this if the value is limited?'

It really depends on where you are and what you look like. If you're a standalone hospital and you're out in the Midwest all by yourself somewhere and all patients come to you already, you don't have as burning a platform. If you live in a place like where we are and your patients are in an accountable care organization and they're going to the hospital down the street, you're going to want to know about that because you're going to still be responsible for coordinating and managing that care.

I think the issue with the HIEs is they're just growing and they're just starting to get to the point where there is a value proposition for them.

FHIT: You mentioned that the infrastructure has to be built. Do you think that accountable care provides that infrastructure?

Reed: Accountable care provides us with the reason for the HIEs. The other reasons were well and good, but they were more of that apple pie and the really good mission for better patient care. If you want to put dollars and cents for a value proposition, you're probably going to look at accountable care, because you're going to want to see any kind of test result treatment that a patient's had at any provider.

FHIT: Forty-six percent of respondents to a recent survey of health CIOs called the ONC's performance with regard to HIEs "not so good." What do you make of the assessment that ONC is to blame?

Reed: I don't know if they're to blame. I think there could have been some more rules or standards laid out. I think there just wasn't a lot of direction as to where to start.

FHIT: Do you think there's anything they can do going forward to improve the situation?

Reed: I'm not really sure. I think they can still continue to work toward the standards and there still is regulatory work, privacy and security laws...I think they have to lay out more clarity around those things.

FHIT: What would say keeps you up at night with regard to Meaningful Use?

Reed: I think it's probably doing the attestation and thinking that everything is correct and then finding out that it's not. Because you have to rely on certain scorecards and the way data is collected. I think we just saw something from a vendor--GE--on noticing that there was a flaw in their scorecard algorithms. I think that frightens me because, as a CIO, what you're saying to me is that I kind of attest to the fact that we do this. That scares me a little bit.

What really frightens me though, is that at this point in time, are we still taking care of patients as opposed to just trying to get these implementations out the door? If you have to spend all your time learning how to run this new program or learning how to do this new function, the level of change for the caregiver is huge, to the point where they're as stressed as my staff. Does that impact the care that we're giving our patients?

FHIT: What else makes you nervous?

Reed: The benefit to these EHRs, especially the ambulatory EHRs, at the end of the day, is going to be having those things connected to something. A standalone system does help you in some ways, but the real long-term benefit is going to have those things be interoperable outside.

Some people still think that if they buy an electronic health record, they're going to get everything. They don't understand that they've got to be connected to something else to be able to see results from the hospital or from the guy down the street. I think it's the level of understanding and the level of support that the physicians are going to need.

That is technically what the regional extension centers are supposed to be helping with, but I think from that perspective, you get mixed reports there, too. I've talked to physicians who absolutely love the interaction, but some others don't even want to bother. Signing physicians up is one thing; getting them engaged is another.

This interview has been edited and condensed for clarity.