2013 – Heading into the home stretch

Happy New Year to all!  We end our 3rd year of operations feeling good about what has been accomplished so far, but a bit apprehensive about the daunting tasks that lie ahead. We have always known the job would get harder as we neared the end of the grant – well, here we are!  On the up side, we end the year with more than 8,500 providers enrolled in our program! I am amazed that we keep adding providers, even though we have limited ability to provide subsidized services. Yet they keep coming!

Almost 80% of our providers have successfully installed an electronic health record, and more than 1,100 providers have  demonstrated they have achieved meaningful use. While this is only a bit less than 20% of our total goal,  it is important to remember that for many RECs, 1,100 providers is their total goal!  The size and scale of our efforts continues to inspire us to move forward so we can make a real difference in California and across the nation.

We start the year with a goal of helping more than 5,000 providers achieve meaningful use over the next 12 months. WOW – that is a pretty big number, and not a lot of time. We will need all of our partners – the LECs, our Service Partners, and of course our talented CalHIPSO staff, to pull together, and keep focused on the task at hand.

We have the added opportunity to use the next 12 months to transition CalHIPSO from a grants management organization to a service organization able to offer a variety of products and services of value to our customers.  Watch for the launch of of these activities over the next few weeks.

As always, we cannot do this work without the support of our many partners. Thanks to everyone who has contributed to our success thus far. I look forward to an exhilarating 2013!

 

Reaching for the Summit….

How did it get to be the 3rd Quarter of the 3rd year of the REC program? Over the summer, we have turned the corner and we are now approaching the final leg of this very high mountain we are climbing.  We have 17 months left to reach our ambitious goals. With 65% of the time gone, we have achieved 56% of our milestones. Not bad, but as we have always said, the last sprint, the one where we help more than 6,000 providers achieve meaningful use by the end of 2013, will be the hardest. We were right.

The REC/LEC partnership is stronger than ever as we drill down into the detail needed to manage hundreds of practices and thousands of providers, in 56 of California’s 58 counties. Here at CalHIPSO we have beefed up our ability to capture the many data elements that we need to monitor this massive endeavor.  At the same time, we have added some technical assistance resources that we hope will help our LECs and Service Partners help providers more easily. We may not make all of our MU goals this year, but next year…..watch out!

At the same time we are reaching for success with the REC program, we are planning for the transitions needed for CalHIPSO to “pivot” from an organization that can successfully manage $35 million in federal funding to one that can be self-sustaining after the REC funding ends in early 2014.  We are so pleased that Karynsue Rose-Thomas, who currently directs the successful REC program for CalOptima in Orange County, will be joining our team on October 1 to lead our business development efforts. The Board of Directors is putting the final touches on our business plan that will help guide the development of products and services designed to be of value to providers and others. Stay tuned for more information about our sustainability program over the coming months.

September 10 – 14 is National HIT Week – time to celebrate the many ways that technology can help support the road to health reform and the transformation of our health care delivery system. I am privileged to be a part of this important effort, and to be working with so many other talented folks within California and around the country who share in this vision.

A Visit from the ONC

We were thrilled to have Mat Kendall, ONC Director of the Office of Provider Adoption Services (OPAS!!) visit us here at CalHIPSO! We gave him the tour of our new offices by Lake Merritt and he left with a Cal HIPPO to take back to Washington DC.

A Really Great Week At CalHIPSO!

Regular readers of my blog probably notice I love to share good news about our program.  Well, it’s only Thursday, but this week has just been overflowing with great big wonderful events.  We started the week with a confirmation of additional core funding to help us operate our program through early 2014.  This allows us to pay for the really boring, but important items like rent, phones, and auditors. We have been waiting to hear about this additional operational funding for many months, so it is relief to finally have some certainty that we can continue to support providers in their journey to meaningful use.

And speaking of certainty, we join the rest of the health care community in celebrating today’s Supreme Court ruling upholding the major elements of the Affordable Care Act. The dream of universal coverage is within reach now, and the fundamental changes to payment and delivery will help keep people healthier and at less cost. Health information technology is an important part of this transformation, and we are thrilled that the journey to universal coverage will continue.

With the culmination of this year’s state budget process, we can also celebrate a smaller, yet critical victory for California’s Medi-Cal providers. For the first time since the program started two years ago, the state is contributing the 10% match funding required to operate the EHR Incentive Payment Program. The $200,000 included in this year’s state budget enables the state to draw down almost $2 million in federal funds to operate the program. Most importantly, this is an annual committment, so we can be assured that the state will continue to be able to meet its obligations to providers to pay out EHR Incentive Payment Program funds through the next nine years of the program.  It was a truly collaborative effort of our provider associations, the State HIE office,  and the staff from Medi-Cal to make this happen.

Finally, as we reach the end of the quarter, we are so proud of our Local Extension Centers and Service Partners, who helped us exceed our quarterly EHR Adoption goals, and get close to reaching our MU goals for the quarter. We now have more than half of our 7,960 providers who have an EHR installed, and 7.5% of them have either attested to MU or demonstrated their ability to do so through an MU simulation tool provided to us by the ONC.  Believe it or not, we are almost half-way toward meeting all of our milestones and are feeling confident about going the distance. All in all, a really great week here at CalHIPSO!

We’re getting traction

On May 17, five minutes before the start of our Open House event at our new offices, a big “yahoo” comes from the cube area. The staff announce that we have finally filled all of our Milestone 1 subsidized slots. It has been ironic these last few months as our overall enrollment has been climbing, but we still couldn’t fill our last few Milestone 1 slots. But now we have and it feels like a great accomplishment.  Our overall EHR adoption rate is above 45% and finally, our Meaningful Use numbers are starting to rise. Not bad, since moving was such a distraction.

We love our new space – it is full of light, close to water, and in a great neighborhood. My artwork and pottery that I can’t store fills the walls and shelves (there are some perks to being CEO) but it seems like folks share my tastes! So we are digging in for a long summer that will be focused on meeting our milestones, practice by practice, LEC by LEC.

We published our first annual report (actually, it covers two years), and it looks great. We received a lot of media coverage for it, which surprised me, since I didn’t think it was that newsworthy. But there is something about being the largest REC in the country that is getting people’s attention. If you haven’t seen it, check it out on our website.

Life on the boat is good – we are doing more sailing as the weather warms up. We took “the house” out to Pier 39 for the Golden Gate Bridge 75th anniversary celebration and it was a strange feeling to realize that everything we need was right there with us!

Our First $50 million!

We are all feeling pretty good here at CalHIPSO. Medi-cal has released the names of the first 5,200 providers who have registered for EHR Incentive Payments and submitted the documents necessary to prove they have a contract for an EHR system. More than 2,200 of these providers are CalHIPSO members, ready to receive more than $48 million! Combined with those 136 providers who will get payments from Medicare, we have helped bring more than $50 million into the hands of California physicians. Not bad for the first quarter of the New Year!

Our transition to CalHIPSO 2.0 is almost complete. This month we are moving to “uptown” Oakland, to a building across from Lake Merritt. For about the same amount of rent we are paying now, we get about a third more space, a better office layout, and a more tranquil neighborhood. It is another PHI space, so once we again, we benefit from existing infrastructure and eliminate the need to purchase office furniture and fixtures. All in all a great deal, and comes at just the right time.

We are truly turning the corner from encouraging providers to join us on the journey to meaningful use to delivering on our promises. Not always easy, not alway perfect, but we are encouraged by the large numbers of our members who are among the “early adopters” of this movement.

We Begin Year 3….

We ended 2011 with a BANG!  Despite the holiday season, neither the LECs nor CalHPSO staff stopped working, and when the dust settled, we ended the year with more than 7,500 enrolled providers – more than any other REC program in the country! We currently only have less than 250 subsidized slots available, and all but two of our LECs have filled all of their subsidized slots. Wow – what an accomplishment!

But as usual, we can’t even stop to take a breath.  California has been “volunteered” by the Office of the National Coordinator to be one of six states participating in a Meaningful Use Acceleration project. This means that all of the ONC-funded projects in California are now being asked to work together toward meeting some very ambitious performance goals relating to how many providers will get payments from Medi-cal and CMS for meaningful use. While it certainly is nice to have company as we speed along the path to Meaningful Use, it is not at all clear whether this new approach will be helpful for us or just result in more work that doesn’t actually help us meet our goals. Unlike any of the other ONC projects, our funding is directly tied to provider’s demonstrating they can achieve MU, so if any activity doesn’t really help with that, then it is not that useful for us right now.  And we are still up against the reality that providers really don’t have to move as quickly as we would like them to. Under both the federal and state programs, providers can wait another year or two, and still receive all of their funding. Yet, in order to demonstrate the impact of the stimulus program this year, the RECs, along with the other ONC programs, are being asked to work even harder, and faster, to get federal money into the hands of providers.

I’m not being cynical – I do understand the need to demonstrate the value of this massive public investment in health information technology. But it is important that we not forget how difficult and expensive this shift from paper to electronic heath records is. We are supposed to “meet providers where they are”, and sometimes that means that they are not ready. Luckily, in California, we have lots of providers who do seem to be ready, so we are optimistic that we will meet our goals.

Meanwhile, three days back from HIMSS 12 and still recovering. The combination of being in Las Vegas, one of my least favorite places on earth, and the crush of 35,000 hyped-up HIT professionals left me unusually drained and exhausted.  But it was exhilarating as well – as the largest REC, we are right in the eye of the storm. With all of the emphasis on data analytics and what “to do” with all of the clinical data now available to providers, it felt good to announce our new partnership with MedeAnalytics to help harness the power of data for safety-net providers.

Everyone has been asking what it is like to live on the boat! After four months on-board, I can report that it is just fine. My husband Dave has worked hard to make the boat warm, dry and comfy. We have taken “the house” out for a sail a couple of times now, and she sails great! It is really cool to think that when we go out sailing on the bay, we have everything we will ever need to live right on board with us. We are eagerly waiting for the time change, so we can spend more time outside in the cockpit.  After a long day at CalHIPSO, I will look foward to watching the sun set over the masts of the other boats  in the marina.

A little house that floats

Half way around the world and back, and now living in a very small house that floats.  Lots of transitions. It was good to be really gone for a couple of weeks–Australia is far away, and the time change makes it hard to keep in touch. That’s good. But it was good to get back and begin our big move off land and on to the boat. Getting rid of stuff was fun, mostly. We didn’t care about making too much money on getting rid of things, so we had the luxury of giving things away or selling them at very low prices. That is a gift. We are pleased to know that our stuff is scattered in lots of places – several CalHIPSO staff now have Mexican rugs we bought from Oaxaca many years ago. Our pottery collection graces the CalHIPSO office.  Our load feels much lighter.

So folks are asking what it  is like  living on a boat. The answer is: interesting. The boat is very comfortable and we have arranged her to make it possible for me to get to work  every day, dressed for whatever the day brings ( eg.  very formal or not). I am blessed to live less than 10 mins from my office, so there is  lots  of leeway in the morning. That’s good, because things sometimes take longer than expected.  But the payback, for us, in living in this  small a space is the fact that we can sail our home on the water, which we did today, finally. There is a reason these voyages  are called “shake down” cruises.  Things did shake down, even though we had planned ahead and lashed things down. But it is an amazing feeling to be sailing on the bay, in your house, and know you can really go anywhere on the water in the world.

Meanwhile, at my day job, it just keeps getting more interesting, and harder. While we at CalHIPSO are pretty pleased that we are reaching our enrollment goals, ambitious as they are, the ONC has moved passed us and are gearing up for next year. CMS is sitting on $34 billion and next year, with a presidential  election coming, that is  a large target. ONC has upped the ante, and all the RECs are being askd to do even more, and more quickly, to demonstrate the impact of the stimulus program. The goals the ONC are setting are a bit unrealistic, but  sure, we’ll get on board. But we also won’t kill  ourselves dong it. At some point, when you are asked to do the impossible, you just take a deep breath and say, OK, we’ll try. If everyone else gets on board, then we have a chance to make it. I’ve said it before, and I’ll say it again: it takes a village.

 

 

 

CalHIPSO 2.0

In the past month, we hit the bottom of the “j-curve”, and have roared up the other side like a rocket! The bottom was the word that Reena Samantaray, our extremely talented Director of Outreach would not be coming back from maternity leave. Understandable, from her perspective, but a real blow from our perspective. Reena’s past experience with the New York City PCIP program (the model upon which the national REC program was built) combined with her unstoppable drive to successfully enroll thousands of physicians in California in a very short time-frame positioned us for our current success. We owe so much of our success to Reena, and we wish her the very best as she embarks on the next chapter of her life.

But how to replace her? Fact is, we can’t, but her leaving created a space for us to bring on another senior leader. With more than 6,000 currently enrolled in CalHIPSO, our enrollment task is nearly done. However,   we are now facing the daunting task of helping these providers actually adopt EHR.  Who better to help us than the director of one of our most successful Local Extension Centers? Welcome, Bre Jackson, formerly with Lumetra Healthcare Solutions and now Chief Information Officer for CalHIPSO. Bre is well-known in the Bay Area as a smart, hardworking HIT professional who knows how to work well with physicians. Sounds like just what we need! And stay tuned for more new staff as we retool ourselves to support the intensive adoption phase ahead of us. 

On a personal note, my husband Dave and I have taken the plunge, and purchased a 1998 41′ sailboat. By the end of October, we will have moved out of our beautiful Alameda rental and will be living aboard the boat in a marina in Alameda.  As romantic as that sounds, I am sobered by the fact while it is a pretty large boat, it is also a pretty small house.  However, we have lived in very small spaces before, and there is  something exhilarating about purging all of the “stuff” accumulated after 26 years of marriage, and deciding on what is the most important to keep. We are aided by a small storage shed, and many friends and charities who are the beneficiaries of our efforts.  And if you visit the CalHIPSO office, you will note a wide array of pottery that did not make it to the boat, and really should not be stored.

For those worried that moving on board suggests we might sail away soon, rest assured that our plan includes staying here in the Bay for several years, so we can learn all there is to know about life on our boat, including how to fix things that break, and how to sail her in all kinds of conditions. But yes, the plan is to eventually sail south, and head to Mexico and points beyond. But not yet. For now, there is an organization to grown and nurture, and many challenges ahead.

Next week, Dave and I fly to Australia, where he is giving the closing keynote speech at the HIMMS Asia-Pacific conference in Melbourne.  Pretty cool! I will play tourist while he does his conference thing, and then we have a glorious two-week trip planned that includes the opera in Sydney and some serious face time with kangaroos and penguins. Regular readers of this blog may remember our ill-fated vacation last year, when we got up-close and personal with Hurricane Earl. We are hoping for a much better experience this time.

Remember the J-Curve…..

For those of you who have studied change management, the J-curve is a very common phenomena that has the potential to sink projects if not handled properly. Most change management projects start out with a bang!  The project champion gets everyone enthused, brisk progress is made toward key project milestones, and everyone feels good. The success curve is going up. Then reality sets in.  There is resistance. There are competing priorities. The success curve starts to go down. The key to stopping the down-hill slide is to remember some key elements of change management: Change is hard. Monitor what is not working and make adjustments. Help people keep their eyes on the end goal. Celebrate success frequently. Understand that the J-curve exists, and that the success curve will go up again – until it goes down, again. This work is like a spiral – we move forward rapidly, we slow down and perhaps even go backward. But we keep moving forward and upward, with our eyes on the end goals.

So here at CalHIPSO, we are in the middle of our own mini J-curve spiral.  We are experiencing some of the stresses that providers will be facing as they add new technology, change their work flow, learn new systems, and keep up with the rapid changes in the HIT field. We all acknowledged that it would be hard to find staff who can help providers navigate the complicated world of EHR adoption – and we find ourselves here at the REC-level being challenged as well to find staff who not only have relevant experience in the EHR/HIT field, but who can apply that experience in ways that will benefit our customers:  the Local Extension Centers, our Service Partners, and of course, our providers.

Several members of the CalHIPSO team that supported us through start-up have moved on for a variety of reasons, and we are in the process of developing a new team that will dig in and manage the complex project that we have signed up for.  That is both stressful and exciting -  everyone who has worked here at CalHIPSO understands how important their individual contributions are to the success of the whole. Even as we look forward to the arrival of new staff, I want to acknowledge the many contributions of the start-up team who helped us acheive our early success and hit the ground running.

The other day, Dorian and I were meeting at the corporate headquarters of one of EHR vendor partners and as we were describing our progress, an Executive Vice-President looked at us and said, “Wow, you’ve done a lot in a short-period of time. How many staff do you have?”  The answer right now is: not enough. But what is great about our partnership model at CalHIPSO is even while we experience some internal challenges, our partners are going full-speed ahead! We are at 72% of our provider enrollment goal and with five months left, I am confident we will hit our target! And we starting to see real growth in our Milestone 2 numbers – over 1,000 providers who are already using an EHR. And gosh, four providers have already achieved Stage 1 Meaningful Use – only 6,183 to go!  But as they say, every  long journey begins with a few small steps. Onward…….