Pushing Ahead at Legacy Health in Oregon: Focusing on the Triple Aim

Jan. 10, 2014
John Jay Kenagy, Ph.D., senior vice president and CIO, and CISO, at Legacy Health System in Portland, is helping to lead major change at his organization, and using the principles of the Triple Aim to help focus on what to change.

John Jay Kenagy, Ph.D. is senior vice president and CIO, as well as CISO (chief information security officer), at Legacy Health System in Portland, Oregon, and has been serving in that role since March 2012. There, he is responsible forstrategic management and operational oversight for Legacy’s information systems and services functions, supporting a six-hospital, 50-plus-clinic, community owned, integrated health system.

Dr. Kenagy, who leads a team of 275 IT professionals at Legacy Health, will be participating in a panel entitled, “Health Care 2020: The Hurdles and Opportunities Ahead,” which will examine the key challenges and opportunities ahead for hospitals, medical groups, health plans, and employers, to leverage health IT to improve healthcare, at the upcoming Health IT Summit to be held January 21-22 in San Diego, sponsored by the Institute for Health Technology Transformation (iHT2). The Institute became a part of Vendome Group, LLC, Healthcare Informatics’ parent company, in December 2013. Kenagy spoke recently with HCI Editor-in-Chief Mark Hagland about the initiatives he and his colleagues have been leading at Legacy Health. Below are excerpts from that interview.

What are the top goals for your health system these days?

Boiling it down to its simplest parameters, it’s the Triple Aim: better-quality healthcare, with better access, at lower cost. [The Triple Aim is a concept that has been developed and promoted by the Cambridge, Mass.-based Institute for Healthcare Improvement.] And people have been talking about that for decades; but this is an opportunity for us to, truly informed by data, provide better care coordination, better management of those with chronic illnesses, provide better management of ED utilization; bring people into primary care via the ACA [Affordable Care Act]; and manage disease better. And Oregon has been on the map for really wanting to change our Medicaid program, and bring dental, behavioral, and physical health together. And that’s provided us with the opportunity to try to integrate those, for a population that has high levels of co-morbidity. So payment reform and collaboration among previously competitive health systems, has helped us get there.

John Jay Kenagy, Ph.D.

There is a clearer policy landscape and set of imperatives for CIOs and for patient care organizations now, would you agree?

Yes, I would agree. And with meaningful use, which is a shorthand for an incredible amount of work—but with physicians and hospitals on electronic systems and with electronic systems needing to operate in a standards-based way, things are beginning to move forward. And, consider this: if I can money out of an ATM in Greece, why can’t I get the fourth- and fifth-floor ICUs in my hospital to communicate? So with so many more electronically driven interactions, the onus on CIOs and CMIOs is to help facilitate better decision-making from the point of care to across the entire ecosystem. And it’s not like we have a better situation than any of our competitors or a worse one. But in an academic medical center, the faculty is driving the decision-making; and at Kaiser, the Permanente Group is doing so; and at Providence, increasingly, they’re using physician employment to drive decision-making. But for us, it’s all about collaboration. We are a mixed model, with some employed physicians, but out of 2,000 members of our medical staff, about 400 are employed. So we don’t have a strategy that disenfranchises independent physicians. We’ll host Epic if you want it, or integrate through our private HIE, if you want to go that route. And anything around care transformation is really better coordination of care, and better surveillance of care. If you’re a diabetic, and have not been seen recently, there should be a trigger for us to check in on you.

So what are your biggest challenges right now as a CIO?

That’s a great question. There are a number of them. I think with business intelligence and HIE, I would say that we’re struggling with the infancy of the industry as we know it. The tools are really blunt, we’re really in the Stone Age right now, the Paleolithic period of tools in healthcare. KLAS recently did a monograph on the stage of the art of business intelligence, and it was really a perception study; it was fascinating. You’ve got Cognos, IBM, Oracle, Microsoft, the big players outside healthcare that want to get into healthcare, but the tools don’t really fit super-well  in healthcare yet; so the tools are somewhat immature. And managing expectations with insurers; some of them are pushing us along, but they don’t know what they don’t know.

In the past, I’ve said that when we go out to talk business intelligence with our clinicians, it’s like asking a caveman before fire has been discovered, whether he’d like his stake medium well done or rare! So we’ve seen a vision—kind of hazy—the tools are really mediocre—but we’ve conceptualized what this will mean to people. When I’m treating the patient, I want to know what other drugs the patient is taking that might interact. But the population: not just John the diabetic being treated in clinic today—but all the diabetics, how are you treating them? And now that you have the data, you can look at the anomalies.

And the reality is that the tools have been very focused on reimbursement processes until recently.

Yes, it’s like checking into a hotel, the registration stuff—that’s what’s been in place historically. So the three big barriers we face: the inadequacy of tools, the end-users not understanding what’s going on; and the inability to find talented staff around business intelligence. So you have talent who know BI through Cognos or Informatica, but they get confused in healthcare; and those with a healthcare background don’t have the BI background; so we’re really having to build our foundation from the seed level.

What will happen at Legacy in the next couple of years?

Three things really: first, getting patients access to their own notes. So we’re using MyChart via Epic; we’re also part of the Open Notes Consortium. That’s really a movement being supported by Consumer Reports, the magazine, to basically facilitate online access to everything your physician writes in their progress note. So, patient engagement around their own patient information. The second is health information exchange—continuing our rollout, hopefully faster, of connecting our Epic to private physician offices’ EMRs. And the third big thing is the enablement of care transformation, of care coordination; so, population health, disease management, case management. All of our primary care practices are already stage 3 patient-centered health homes. We’ve been operating that for the last seven years.

What do you see happening in the industry in the next couple of years?

Great question. The hubbub I’m hearing around meaningful use Stage 2 not taking the foot off the accelerator—that’s going to be an important factor in all this. I recently read that 1,000 vendor products were certified for stage 1; and as of a month ago, only 98 had been certified for stage 2. I think that there’s going to be a dramatic moment—it’ll be sort of like a meaningful use stage 2 Y2K. I think you’re going to have companies that won’t be able to do it, that will close down product lines. So that’s a big deal in the industry. Sand the shakeup of the requirements for better reporting, via HIE and BI—if you can’t do that, you’re not going be able to move forward.

What would your advice be for fellow CIOs and CMIOs be, around the welter, the plethora of demands and priorities right now?

I feel lucky that this organization had made smart decisions around its core infrastructure, prior to my coming here. And the CEO uses our Epic implementation of an example of how our organization can be brilliant when it wants to be. The decision to do Epic was a remarkable one. I mean, if I were a CIO with a different vendor, I would be worried. And Epic has its warts for sure, of course. But the number-one thing is, use the meaningful use dollars to bring clinicians along. I’ve had some of our hospital leaders, our clinicians—when we’re talking about meaningful use stage 2—and we’re in our reporting period, January through March, the second quarter of the federal fiscal year, and stage 2 is really tough. But one of our physicians said, you know, what you’re measuring is the stuff you should be doing anyway.

So use that, and excite people around meaningful use, and really become meaningful users, and focus on safety and quality and exchanging data with other systems. As you said, there’s clarity around policy, and frankly, I think that it’s wonderful that federal policy and the core ideas of the Triple Aim are really well aligned. So become truly meaningful users; drive your user community forward. This is a great time. And between now and the end of the decade is really the time for healthcare IT.

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