A bea­con for IT

Blu­ford takes a high-tech, high-touch ap­proach

Modern Healthcare - - CEO IT ACHIEVEMENT AWARDS - Andis Robeznieks

Even as the Tru­man Med­i­cal Cen­ters sys­tem in Kansas City, Mo., re­ceived recog­ni­tion for achiev­ing the high­est lev­els of in­for­ma­tion tech­nol­ogy adop­tion, Pres­i­dent and CEO John Blu­ford was also ex­plor­ing a low-tech ap­proach to im­prov­ing his com­mu­nity’s health: open­ing a gro­cery store.

“It’s an ex­am­ple of us treat­ing pa­tients out­side of the hos­pi­tal bed,” says Blu­ford, who has led Tru­man since 1999. “Suc­cess­ful or­ga­ni­za­tions in the fu­ture will need to be both high-tech and high-touch, and they will need a fun­da­men­tal un­der­stand­ing of the neigh­bor­hood and com­mu­nity they serve.”

Fundrais­ing is just get­ting started for the $11.5 mil­lion pro­ject that will be car­ried out by the Hos­pi­tal Hill Eco­nomic De­vel­op­ment Corp., a not-for-profit en­tity led by Tru­man to sup­port healthy life­styles in the neigh­bor­hood around its TMC Hos­pi­tal Hill fa­cil­ity—an area known as Bea­con Hill. The neigh­bor­hood has been clas­si­fied as a “food desert,” with just one “high-dol­lar spe­cialty” re­tailer serv­ing as the only gro­cery store within a 1.5-mile ra­dius. Blu­ford, 64, serves on the board of the eco­nomic de­vel­op­ment group, and he says the store will be one way the sys­tem can tar­get health­care con­di­tions “with a strong nu­tri­tion com­po­nent,” such as di­a­betes, hy­per­ten­sion, obe­sity and sickle cell ane­mia.

Blu­ford says health­care or­ga­ni­za­tions “need to get out in front” in fight­ing th­ese chronic con­di­tions, adding that “the gro­cery store is about pro­mot­ing health and pre­vent­ing dis­ease.”

The same is true with his or­ga­ni­za­tion’s use of health in­for­ma­tion tech­nol­ogy. Out­side of its hos­pi­tals, Tru­man is do­ing ZIP code track­ing of where dis­eases are most con­cen­trated as well as an­a­lyz­ing ar­eas of ser­vice uti­liza­tion and hos­pi­tal read­mis­sions. In­side the hos­pi­tals, Tru­man has used IT to re­duce the in­ci­dences of bed­sores by 69%, and saved $3.6 mil­lion in the process.

IT is also vi­tal to the 63,000 chron­i­cally ill pa­tients Tru­man serves. Its use of IT in man­ag­ing the care of its asthma, con­ges­tive heart fail­ure, chronic ob­struc­tive pul­monary dis­ease, di­a­betes, hy­per­ten­sion and sickle cell pa­tients has helped Tru­man earn the National Com­mit­tee for Qual­ity As­sur­ance’s des­ig­na­tion as a Level 3 pa­tient-cen­tered med­i­cal home—the NCQA’s high­est level of med­i­cal-home recog­ni­tion.

A Health­care In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety sub­sidiary, HIMSS An­a­lyt­ics, has be­stowed its high­est level of recog­ni­tion— its Stage 7 award—on less than 2% of the na­tion’s more than 5,000 hos­pi­tals. In­cluded in that 109-mem­ber elite group are Tru­man’s two hos­pi­tals, 272-bed Hos­pi­tal Hill and 98-bed TMC Lake­wood. Add to that recog­ni­tion Blu­ford’s se­lec­tion as one of this year’s two CEO IT Achieve­ment Award win­ners.

With a fo­cus on im­prov­ing qual­ity and pa­tient safety, Blu­ford set a one-year time frame for im­ple­ment­ing the sys­tem’s elec­tronic healthrecord sys­tem. His in­volve­ment was said to be crit­i­cal to the ef­fort. “It’s an ab­so­lute im­per­a­tive that you have ex­ec­u­tive lead­er­ship on board in any IT im­ple­men­ta­tion,” says Amye Gilio, Tru­man’s di­rec­tor of nurs­ing in­for­mat­ics.

One fo­cus for the nurs­ing side was elim­i­nat­ing re­dun­dant doc­u­men­ta­tion, which Gilio says gives nurses more time to spend with pa­tients as well as con­tribut­ing to their peace of mind. “If you don’t have time man­age­ment, you have noth­ing—be­cause you have to have time to spend with pa­tients,” she says. “Also, we have the com­fort of know­ing we have all their in­for­ma­tion and we can make de­ci­sions safely and ef­fec­tively be­cause we have an in­te­grated clin­i­cal record.”

On the physi­cian side, Dr. Jef­frey Hack­man, Tru­man’s chief med­i­cal in­for­ma­tion of­fi­cer, noted how im­ple­ment­ing health IT can be ex­pen­sive, and he cred­its Blu­ford with get­ting the sys­tem to where it is to­day.

“I think John’s big­gest con­tri­bu­tion along those lines is—in his time as CEO in an or­ga­ni­za­tion like ours, where truly ev­ery penny mat­ters—he’s shown a com­mit­ment to IT,” Hack­man says. “He helped push us over the tip­ping point and helped the board un­der­stand why we were go­ing to spend so much money on some­thing that may not have a true fi­nan­cial ROI, but will help us do what’s best for our pa­tients.”

Last year, in ad­di­tion to pro­vid­ing more than $125 mil­lion in un­com­pen­sated care, Tru­man had rev­enue of $702 mil­lion and an IT bud­get of $25 mil­lion, which in­cluded 109 peo­ple on staff. This ac­counts for 11% of Tru­man’s cap­i­tal ex­pen­di­tures and 5% of op­er­at­ing ex­penses. To doc­u­ment the suc­cess of the EHR sys­tem since its July 2009 roll­out, 20 monthly per­for­mance mea­sures were set to gauge qual­ity, safety and op­er­a­tional ef­fec­tive­ness ben­e­fits the IT sys­tem gen­er­ates. So far, $12 mil­lion in sav­ings from th­ese ben­e­fits has been doc­u­mented since De­cem­ber 2009.

Hack­man notes how Blu­ford sold the IT im­ple­men­ta­tion as some­thing that would si­mul­ta­ne­ously put Tru­man ahead of the curve as an in­dus­try leader and also help achieve bet­ter out­comes for pa­tients.

Hack­man says that, on the hos­pi­tal side, Tru­man has met the Medi­care and Med­i­caid Stage 1 re­quire­ments for HHS’ EHR mean­ing­ful-use pro­gram and is in the mid­dle of the Stage 2 process. He notes how most Tru­man providers also met Stage 1 re­quire­ments and are in var­i­ous stages of meet­ing Stage 2 cri­te­ria.

Per­haps pre­dictably, Blu­ford de­flects credit for Tru­man’s IT suc­cess back to his staff. “If you don’t have physi­cian and nurs­ing buy-in, then it’s not go­ing to work,” he says, adding that physi­cian and nurse lead­ers is­sued a procla­ma­tion about how im­ple­ment­ing IT was some­thing Tru­man must do to be com­pet­i­tive.

“I think it is a sig­nif­i­cant com­pet­i­tive ad­van­tage,” Blu­ford says. “One of our strate­gic goals was to use IT for com­pet­i­tive ad­van­tage in re­cruit­ment, qual­ity and safety.”

Gilio agrees that Tru­man’s use of IT helps the or­ga­ni­za­tion re­cruit top peo­ple. “This is the gen­er­a­tion of tech­nol­ogy and in­no­va­tion,” Gilio says. “New nurses look to see how out­moded you are, and then are very happy to see we have a full suite of tech­nol­ogy tools spe­cific to the nurse.”

Hack­man says Tru­man’s high level of IT

adop­tion also helps keep physi­cians from look­ing else­where. “That’s a sig­nif­i­cant re­ten­tion is­sue for the med­i­cal staff,” he says. “It’s a huge point that we have peo­ple prac­tice in an en­vi­ron­ment where they have ready ac­cess to the in­for­ma­tion they need.”

Blu­ford says sell­ing staff on us­ing IT has got­ten a lot eas­ier than it was 10 to 15 years ago.

“In fact, it’s not a sell—the docs are buy­ing,” he says. “Most top-flight clin­i­cians want to come into an en­vi­ron­ment that has all the bells and whis­tles that will help ex­pe­dite their abil­ity to see pa­tients most ef­fec­tively. Also, if you don’t have it, they’ll go some­where else.”

Tru­man has es­ti­mated that its IT sys­tem has helped save more than $5.2 mil­lion through re­duced use of sup­plies, re­duced tran­scrip­tion ex­penses and “real es­tate op­ti­miza­tion” as the sys­tem has moved to pa­per­less op­er­a­tion.

“We don’t have stacks and stacks of med­i­cal records any­more,” Blu­ford says.

Cerner Corp., also based in the Kansas City area, is Tru­man’s main IT part­ner and EHR ven­dor. But Blu­ford says that it’s more than geogra- phy that has made the 14-year re­la­tion­ship work. “We’ve had the ‘A Team’ from Cerner,” says Blu­ford, who spoke last Oc­to­ber at the com­pany’s Cerner Health Con­fer­ence and at its Mean­ing­ful Use Sum­mit in 2010. “Our phys­i­cal prox­im­ity to Cerner doesn’t hurt. But, more im­por­tantly, it’s the in­tel­lect they bring to the ta­ble and how that in­tel­lect is trans­ferred to our op­er­a­tion.”

Gilio also gives much credit to Cerner’s Mil­len­nium Light­house data anal­y­sis sys­tem for Tru­man’s suc­cess in de­creas­ing pres­sure ul­cers. The sys­tem has also been linked to de­creas­ing the num­ber of pa­tient falls and in­ci­dences of ve­nous throm­boem­bolisms—sav­ing Tru­man about $700,000 in the process.

One of the more dif­fi­cult as­pects of IT im­ple­men­ta­tions for health­care or­ga­ni­za­tions has been adopt­ing com­put­er­ized physi­cian-or­der en­try for elec­tronic pre­scrib­ing, but—af­ter get­ting started on it in late 2009—Tru­man’s CPOE sys­tem is now fully op­er­a­tional across its op­er­a­tion. “We’re well down that road now,” Blu­ford says. While Tru­man has been able to tackle CPOE, Blu­ford ac­knowl­edges that com­ply­ing with HHS’ plan to im­ple­ment the new ICD-10 set of di­ag­nos­tic and pro­ce­dural codes by Oct. 1, 2014, will be an ar­du­ous task.

“I can’t tell you if it’s go­ing to be worth it or not, but I can tell it’s go­ing to be an ex­pen­sive propo­si­tion,” Blu­ford says. “If it is de­layed again, we will be pleased.”

In ad­di­tion to be­ing rec­og­nized as an IT leader, Mod­ern Health­care named Blu­ford as one of the in­dus­try’s Top 25 Mi­nor­ity Ex­ec­u­tives in Health­care in 2010 and 2012. Be­fore ar­riv­ing at Tru­man, Blu­ford was CEO of Hen­nepin County Med­i­cal Cen­ter in Min­neapo­lis. He started his ca­reer in 1972 at Chicago’s Cook County Hos­pi­tal as an evening ad­min­is­tra­tor. He served as the Amer­i­can Hos­pi­tal As­so­ci­a­tion’s board chair­man in 2011.

Hav­ing been an AHA board mem­ber since 2006, Blu­ford says his time with the or­ga­ni­za­tion helped with the IT im­ple­men­ta­tion at Tru­man. “Ob­vi­ously, it’s been very ad­van­ta­geous to see other sites and to see what other peo­ple have done well and to learn from other peo­ple’s mis­takes,” he says. “Peo­ple have good ideas that we’re not em­bar­rassed to bor­row.”

Now, it’s the other way around, Gilio says. Peo­ple are look­ing to Tru­man for ideas and ad­vice. “I fre­quently take calls from oth­ers that are on the same jour­ney be­cause ev­ery­one is on the march to­ward mean­ing­ful use,” she says.

Blu­ford has one main mes­sage when talk­ing to other health­care lead­ers about IT.

“The big­gest mis­con­cep­tion is that it’s a magic bul­let that will fix ev­ery prob­lem,” Blu­ford says. “It’s a tool. You have to have a game plan for the tech­nol­ogy to be as help­ful as you’d like it to be.”

SHANE KO­VAC/TRU­MAN MED­I­CAL CEN­TERS

Tru­man’s John Blu­ford says the em­pha­sis on IT

is for com­pet­i­tive rea­sons as well as the pa­tient-care ben­e­fits.

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