St. Joseph's CMO/CMIO discusses ACOs and Zynx

St. Joseph’s Health System is participating in a health care reform/Accountable Care Organization development pilot program with leading decision support company Zynx Health. In this interview, Dr. Clyde Wesp, St. Joseph’s  Senior Vice President, Chief Medical Officer and Chief Medical Information Officer discusses the experience.

David E. Williams: Dr. Wesp, thank you for joining me today.

Dr. Clyde Wesp:            It’s my pleasure.

Williams:            What is the scope of St. Joseph’s Health System?

Wesp:            St. Joseph’s Health System is a Catholic health system on the West Coast.  We have hospitals in Southern and Northern California and Texas and clinics in New Mexico as well.  We have about 22,000 to 25,000 employees.

We have eight ministries –we call our hospitals ministries because of the religious affiliation– with 15 hospitals.  We have a health system in Texas called Covenant Health System, which is a combination of three hospitals, one of them a Critical Access Hospital.

We have about 5,000 physicians involved in the health system.  The majority of those are independent, private practice physicians.  We have a foundation model in California and Texas. We also have some contract positions for intensive care and emergency services.

Williams:            How would you characterize the system in terms of its maturity in the use of health information technology and clinical work flows?

Wesp:            I think we are quite mature. We use in-hospital technology to achieve our outcomes and deploy technology throughout the continuum of care as well.

Part of our mission is “perfect care.” In order to drive perfect care we realize that we have to have technology to achieve those outcomes. If you do not have technology and evidence based care in your organization you’re not going to be able to achieve perfect care.

Williams:            Many people are talking about the move toward Accountable Care Organizations (ACO’s).  How are you thinking about ACO’s and Saint Joseph’s role in them?

Wesp:            Everyone is talking about ACO’s and some organizations are even declaring themselves as Accountable Care Organizations. We feel that the model is not perfectly developed by any means, so we look at developing the building blocks for whatever Accountable Care Organizations will look like in the future.  We formed a steering committee within our organization that started out as an ACO steering committee. However it has become a health care reform committee because we realize that ACO’s and medical home models are only a piece of health care reform and we don’t know what’s going to happen with bundled payments.

So we ask what are those key building blocks? One that we are working on is our relationship with physicians.  What is our physician integration model or alignment model or partnership model?

Number two is we realize we have to have superior outcomes. To get superior outcomes we are looking at sharing and monitoring evidence based care across the continuum.

Then the last piece of it is efficiency.  It’s very important that we realize where waste is within our organization and what comprises that waste.  We look at overutilization, understanding where we are doing more than we need to in order to achieve the outcome.  Where are we doing things that cause harm?

We are also working with our people who know what’s going on in the federal government to determine where we have the opportunity to give our input as these things develop.  We see it as a great opportunity in health care, although I’m not sure what’s going to happen after this week’s election. We see an opportunity in health care to form the future.  That’s exciting from our perspective.

Williams:            When you develop the building blocks and alignment models with physicians, what role do tools like Zynx order sets and clinical decision support play?

Wesp:            I’m going to put my clinician hat on. Sometimes I find it’s difficult to get non-clinicians to realize what our first love is, which is medicine.  That’s what we went into health care for.  I’m talking about physicians and nurses and other people who really touch patients.

How does Zynx help us?  It helps us put the evidence on the table.  We get to do what we like to do; argue about it a little bit, which is part of what we love to do.  We love the science of it.  We love to say: what is this evidence really telling us?

They help guide us, because looking at the literature it’s so difficult for us to poll everything. It helps drive us in the direction of the right thing to do for the patient. We’ve talked a lot about the timing of this.  How do we make sure the patients get things in a timely manner? How do we build that into our order sets and our evidence based care? We see it as extremely helpful in terms of achieving our goals of tying it all together.

We want to get more on the outpatient side.  We’d like to get more tied into those physicians. Zynx is a piece of our physician integration strategy because it gives us the platform to talk about things that physicians want to talk about, namely the care.

Williams:            You are one of a few institutions engaged in a pilot exercise with Zynx that’s focusing on ACO’s.  Is that just an extension of what you’re doing with the Zynx products or does it include additional activities?

Wesp:            We’ve been in partnership with Zynx for quite a long time. We see this as a key component of what we want to do.  We’ve built our order sets in Zynx. What’s  exciting about this pilot is to be able to take a look at those order sets, analyze the costing of those order sets to understand if we are wasting resources or there might be a better opportunity to do the right thing for less.  That’s where this pilot is very exciting.  It fits into our strategy extremely well.  It’s not the entire ACO spectrum but we see this as a very important part of trying to become more efficient while delivering the highest quality care that we can.

Williams:            How do Zynx products and the pilot fit with other IT components such as the electronic health record and CPOE?  Are they complementary and integrated or is one ascendant?

Wesp:            Zynx is completely integrated with our electronic health record. We have been in a pilot with Zynx and our electronic health record vendor, MEDITECH to build order sets. We have ministries where formularies are different and some of the ways they label things are different.

We are working with Zynx and building order sets that are imported into each instance of MEDITECH at each one of the facilities. There is a lot of consistency there, which we see as crucial.  We just went live with those order sets at one of our ministries in Northern California. Physicians are using them; physicians are happy with them, which drives evidence based order sets at the level of care.

Williams:            You mentioned your enthusiasm about being able to provide input as the country moves forward on health reform. Do you have any thoughts about whether there are going to be opportunities to provide that input, post-election?

Wesp:            There are a couple of avenues that we are pursuing. We feel that the National Quality Forum is an organization that we need to be part of.  Don Berwick moving to CMS and his focus at IHI on quality is an important piece of the picture for us.  As clinicians we feel it’s going to be helpful in making sure the right things get done.

We also are dealing with our legal firm, which has connections in Washington, to give us the opportunity to put our ideas on the table.

Williams:            I’ve been speaking today with Dr. Clyde Wesp from Saint Joseph’s Health System about his organization’s progress with Zynx toward becoming an Accountable Care Organization.

Dr. Wesp, thanks for your time today.

Wesp:            Thank you very much for having me.

November 11, 2010

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