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CEO, QSource

Do not go where the path may lead, go where there is no path and leave a trail. -Ralph Waldo Emerson

Dawn Fitzgerald rides a scooter to work, promotes “green” technologies in the office, plays golf when she can and enjoys long bike rides. For a stress buster, she sheepishly confesses to a propensity for wakeboarding at Pickwick Landing where she spends summer weekends. She balances the challenges of leading a statewide staff of 140 employees by turning to the outdoors for rejuvenation.

For more information and resources, visit websites for: QSource: www.qsource.org Tennessee Regional Extension Center: www.tnrec.org

This keeps her razor sharp and able to respond proactively to unprecedented challenges in today’s healthcare environment.

FitzGerald is the CEO for QSource, the not-for-profit organization that provides quality improvement services for those providers who are reimbursed by the Centers for Medicare and Medicaid Services (CMS). The Tennessee Regional Extension Center (tnREC) is a division of QSource. With headquarters in Nashville, there are also offices in Knoxville and Memphis.

Her energy and commitment are palpable as she talks about her role as CEO at QSource. Her interest in healthcare was piqued while working as a graduate student at night job manning the phone in Shands Hospital medical records department in Gainesville, Fla. She provided the service of transferring healthcare information from the hospital’s medical records department to ERs and loved being involved in the documentation of healthcare quality. The outcome was a refocused interest in line with overall healthcare rather than research - the career path she had envisioned with her psychology background.

As CEO of a non-profit organization how would you describe your management style?
According to my associates, “involved.” My beginnings in healthcare quality began ‘in the trenches,’ first as a data analyst, then a project manager, then operations. Because of that background, I like being involved in the day to day details of what’s happening operationally.

QSource has so much to stay current on with healthcare reform and the HITECH Act. How do you keep your clients satisfied?
Relative to our size, the volume of work that we encompass is quite large. In fact, we are operating 12 contracts simultaneously that vary from $4,000 to a few million dollars a year (the CMS contract). We try to treat everyone equally in terms of setting priorities, getting work done and keeping our customers satisfied, but it is a challenge.

What special challenges have you encountered since you have been CEO at QSource?
The biggest challenge is trying to keep up with the wealth of opportunities available to make healthcare better. QSource has functioned in the arena of improving healthcare, making it more efficient, effective and less error prone. Now we are moving toward improving the health of the population. The question is, ‘How do we educate consumers on living healthier?’ This is a major aspect of the healthcare system.
Presently the focus is on healthcare reform, defined as payment reform. Keeping up with how fast things are churning out in the healthcare industry is a major challenge. Things are going to change dramatically in the next 5-10 years.

What sort of advice do you have for providers as they are preparing to select their EHR systems to ensure compliance with criteria for HITECH incentives?
It is critical to know and to keep up with all changes. Our website provides the latest information.
Also, it is imperative to understand that the purchase alone is insufficient to adopt the EHR. It is more about changing the culture of your practice that will lead to successful implementation. And practitioners should perform a readiness assessment to determine how prepared they are to implement an EHR system.

How does a medical practice perform a readiness assessment?
There are many tools available. Readiness assessments can be found on our website. Important questions to consider are:
• How does the doctor/patient encounter flow in your office?
• How is it going to work if the system becomes electronic?
• Who does the most documentation?
• Who examines the patient and records information?
The first step is to observe patient work flow for a day and document the processes. Identify deficiencies and redundancies in the system. Then build the system capacity around the current work flow and identify changes that will make it more efficient.

What is the key to QSource’s success, not only with the Medicare Electronic Health Record Incentive Program but with future initiatives?
We don’t have an agenda. We are mission driven, not-for-profit and our mission is about quality improvement. We are supportive of every entity involved – the purchaser, the payer, the provider, and the consumer. That places us on neutral ground. When it comes to issues concerning quality improvement, healthcare reform, and implementing health information technology, you have the assurance that the information we provide is unbiased and in the best interests of improving healthcare.

Do you think healthcare reform is likely to enhance your success? How will it affect what you do?
The easy answer is ‘yes,’ healthcare reform will open doors to many opportunities in areas that, historically, we have not been involved. Our capacity has been focused around working in a provider community setting and on improving quality. Now we’re taking a broader perspective which includes the patient. ‘How do we educate the consumer on why the electronic health record is important?’ On the healthcare reform side, there’s an opportunity for us to begin thinking differently - not so much about leading the agenda around cost reform, but helping providers transform their practices to ensure that they are not impacted adversely by healthcare cost reform.

What do you say to the provider who says, ‘I am going to wait for things to settle down before I make changes in response to the EHR mandate?’
No one feels more pain for providers at this point than we do. Frequently, we hear about rural areas with one practitioner. Part of their day is spent trying to determine how they’re going to see 45 patients, get the paperwork done, go home at night and then do it all again the next day. We’re talking about a transformational change in the office practice. But the bottom line is, if you don’t start taking steps now it’s going to be more difficult to catch up. Practitioners should be doing the research and considering what resources they’ll need. That’s a start.

What do you consider your most important achievement at QSource?
We have increased our recognition on a statewide basis as an organization of merit and expanded our capacity to assist the healthcare community. I think we are now garnering recognition statewide for that expertise.

Do you have encouraging words regarding how EHRs can be a win-win for everybody?
It will get better. Imagine as a practitioner what it’s going to be like when we have a fully operational electronic health exchange system. Physicians will know when a patient sees another physician. They will be able to access all patient records to enable them to make sound clinical judgments. We should all be pushing healthcare to be technology leaders, not technology followers.

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Dawn FitzGerald, EHR, QSource, Tennessee Regional Extension Center. tnREC

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