For Dana Moore, becoming CIO at Centura Health didn’t exactly happen overnight. In fact, he jokes it may have been the world’s longest job interview. But for Moore, who first served as interim CIO, persistence paid off. Almost eight years later, the organization is thriving. In this interview, Moore talks about Centura’s Meditech journey, his goal to achieve Stage 6 recognition for all 13 hospitals in 2013, and what it’s like to build from the ground-up. He also discusses the health neighborhoods initiative that is transforming the way care is practiced in Colorado and helping Centura position itself for the brave new ACO world, the work his organization is doing with HIEs, how he has benefited from his experience in consulting, and why recruiting isn’t a huge challenge for Centura.
- About Centura
- Getting Stage 6 recognition across the organization
- Building from the ground-up
- Straddling between two payment worlds
- Colorado’s health neighborhoods initiative
- Working with CORHIO & Colorado Telehealth Network
- Vendor-neutral image archiving
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We try, for the most part, to stay right at our standards. Invariably, we’ll introduce some new piece of technology with the new hospital, and then we’ll take that from the new hospital and roll it out back to all the other facilities.
We’re standing with one foot firmly in the world that we’re in today, where we pay for taking care of people that are sick, while trying to get that other foot into the new world.
We have a strong foundation to allow us to do this experimentation and not have to worry that if we make the slightest mistake, the whole ministry could go under. We’re financially very strong with the balance sheet and we have great leaders.
How do we take care of patients and keep them healthy? The neighborhood concept really allows us and positions us to do that with putting a bolus of providers that patients can get to easily.
We will start sending images to that vendor-neutral archive, which will allow providers around the state to look and say, ‘there’s the image. I don’t need to redo the test,’ thereby reducing costs and also radiation exposure for patients. So we’re pretty excited about that.
Gamble: Hi Dana. Thanks so much for taking the time to speak with us today.
Moore: Glad to do it. Thank you for inviting me to this opportunity.
Gamble: Sure thing. Let’s start by getting some background information about Centura Health. I know that you’re a pretty sizable health system, so give us the number of hospitals, things like that.
Moore: We’re 13 hospitals with the 14th opening later this year. We’re about $2.7 billion in net revenue. We also have roughly 500 employee providers. We have long‑term care facilities as well as home health so we’re a pretty big organization. We’re primarily in Colorado, although we do have a hospital in Kansas now.
Gamble: Where is the 14th hospital that’s going to open this year?
Moore: Castle Rock, Colorado.
Gamble: But most of the facilities you said are based in the States?
Gamble: Okay, so you have the physician group — about how many employee providers?
Moore: Roughly 500.
Gamble: So let’s talk a little bit about the clinical application environment. You’re on Meditech?
Moore: Yes, we are. We have Meditech in our acute care facilities, in our physician offices, and in our home health facilities. We started with Meditech in 2005, went live in 2006 and 2007, starting on the acute care side and rolled out the other areas after that.
Gamble: I want to get into that a little later on — the selection process and the implementation, everything like that. But first I wanted to ask about Meaningful Use and how you’re positioned for that.
Moore: We have attested for stage 1 and received our money. For the hospitals, we’ve received the money. For the physician group, we’ve attested and are waiting to receive the money, so we’re well positioned. We’re actively working on the next upgrade for Meditech. We’ll do that later this year, which will position us for stage 2.
Gamble: What version are you upgrading to?
Moore: Client Server 5.6.6.
Gamble: Okay. So I had read that you had four of the hospitals achieve stage 6 recognition in 2012 and that the goal is to get all 13 on stage 6 this year, is that true?
Moore: Yes, we will have all of our hospitals at stage 6 by June 30,and Castle Rock will open as a stage 6 hospital.
Gamble: Was Castle Rock a different facility that you were taking over, or is it being built from the ground up?
Moore: It’s built from the ground up. We originally built a freestanding ED with some outpatient services, and now we’re building the rest of the hospital.
Gamble: That’s got to be a pretty interesting experience. I’m sure the plus side is being able to put in the technology you want and not having to deal with the older systems.
Moore: True. And we have built this will be our fourth facility we’ve built from the ground up in the past 10 years. We’ve had quite a bit of experience, plus in a lot of our other facilities we’ve done major additions, remodels, etc. We’ve spent quite a bit of money and capital with new facilities for the past 10 years.
Gamble: Are there other specific best practices or things you learned from building the other hospitals that you are applying toward this new one?
Moore: Yes. While every facility is unique as far as its design, from an IT perspective, we have developed a team that manages how we’re going to go in, put in applications, and work with the local leadership on what we’re going to put in. But we try, for the most part, to stay right at our standards. Invariably, we’ll introduce some new piece of technology with the new hospital, and then we’ll take that from the new hospital and roll it out back to all the other facilities.
With this new facility in Castle Rock and the facility that we’re going to be building in northern Denver, we’re really focused a lot more on the patient experience than we have been traditionally. A lot of it has been what do we need for an EMR, etc. So we’re looking at things like kiosks, wayfinding technology, and RFID that we haven’t put in our other hospitals in the past.
Gamble: That’s interesting. We’re seeing more demand for that. Now I really want to talk about some of the work you’re doing with the health neighborhoods. It seems like you’re doing a lot of work with ACOs and payment reform. So maybe we can talk first about possibly the Colorado Regional Care Collaborative Organization and what you’re doing with that.
Moore: With payment reform, our CEO Gary Campbell really talks a lot about first curve, second curve and value. He’s positioning the organization for straddling that world that we’re quickly moving into of not being paid just to take care of people that are sick, but being paid to keep people out of the hospital, which sounds counter-intuitive to many people who have been in healthcare for a long time. We’re standing with one foot firmly in the world that we’re in today, where we pay for taking care of people that are sick, while trying to get that other foot into the new world. We’ve been doing ACO work, as you mentioned, with other organizations on how do we learn how to move to this new world.
We were just named as an ACO in late December, and we are beginning to ramp up for those services. So we’re looking at what do we need from an IT perspective, and what do we need from providers. It’s exciting and a little scary, but we’re moving rapidly down that path. Stay tuned. We’ll see how successful all of these are. I think it’s great that as a country we’re finally recognizing that the current system is not sustainable and we’re looking at what I call controlled experiments on how we reform healthcare.
Gamble: It seems like that’s the tricky part — what you mentioned about how you have to maintain that balance right now between the fee-for-service or traditional model, whatever you want to call it, and the new way of doing things. That’s something I would imagine is a challenge.
Moore: It really is. We’re fortunate in that Centura is a healthy organization financially. We’re also fortunate that Centura has two sponsors that are healthy financially — Catholic Healthcare Initiatives and Adventist Healthcare. So we have a strong foundation to allow us to do this experimentation and not have to worry that if we make the slightest mistake, the whole ministry could go under. We’re financially very strong with the balance sheet and we have great leaders. That allows us to do this and with a little bit less fear of, if this doesn’t quite work the way we thought, we’ll be okay.
Gamble: Sure, that plays a big role. You said that they are sponsorship organizations?
Moore: Yes. I probably should have mentioned this upfront, but Centura is actually a joint operating agreement between Catholic Health Initiatives and Adventist Health. And so in essence, Centura itself is a management company that manages their assets in Colorado, and then in CHI’s case, a hospital and a freestanding emergency room urgent care and ambulatory surgery center in Kansas.
Gamble: As far as the reporting, you have a separate board and everything for Centura Health?
Moore: We do. Separate IT, separate finance.
Gamble: Interesting. Okay, so with the health neighborhoods, is that something that is already happening and that’s already in effect, or is this something that’s kind of still being planned?
Moore: A little bit of both. We have announced the 13 neighborhoods near our current hospitals in the Colorado market. All of our employed providers are part of the neighborhood, and we are now signing up affiliated physicians to be part of the neighborhood. We have some of those that have signed, but it’s still a relatively new concept. Again, it’s a stay-tuned type of thing, but another one of Gary Campbell’s ideas and creation for Centura that is, I think, brilliant.
How do we take care of patients and keep them healthy? The neighborhood concept really allows us and positions us to do that with putting a bolus of providers that patients can get to easily. And the neighborhood model is really tiered. So you’ll have one that might just be primarily a primary care entity to something like we have currently in Castle Rock and in North Denver, which is a really strong outpatient ED presence with a lot of multispecialty groups surrounding it. There isn’t a one-size-fit-all for the neighborhood; it’s what is needed in this community or in this area that we can put there to help keep people healthy.
Gamble: And are you talking about some pretty rural areas with some of the neighborhoods.
Moore: We eventually will get there. We have signed several affiliation agreements with rural hospitals and now we’re looking at, ‘okay, what do we do? What do we need for a neighborhood there?’ In some of those cases, the neighborhood might be primarily telehealth. It might be affiliated with the providers that are there that bring the specialists in via telehealth.
Gamble: As far as HIEs, are you doing anything on that front at this point?
Moore: Yes, we are. We actually started with a lot of health information exchanges which were really delivering results electronically back in 2004. We co-developed MobileMD. This was prior to its sale to Siemens and prior to us having Meditech. So we were sending information from our variety of systems that we had to providers’ electronic health records. We still have MobileMD in place for those that were signed up, but in 2009 we started working with CORHIO as they were coming into fruition.
We’ve been transitioning in 2010 and 2011 and 2012 delivering results via CORHIO. CORHIO is the health information exchange in Colorado. We actually have two. We have Quality Health Network on the western slope and then CORHIO east of the continental divide. We were an early adopter. We continue to work with them and really see a bright future for CORHIO.
In addition to that, we have something in Colorado called the Colorado Telehealth Network (CTN), and that is a non-profit that is under the Colorado Hospital Association and the Behavioral Health Association in Colorado. They got FCC funding and connected over 200 locations — acute care hospitals and behavioral healthcare clinics — with broadband. Once that was complete, we started looking at what else can we do with this wonderful network we have. So we recently announced that we are going to have a vendor-neutral archive that’s associated with CTN. And so again, we’re an early adopter. We will start sending images to that vendor-neutral archive, which will allow providers around the state to look and say, ‘there’s the image. I don’t need to redo the test,’ thereby reducing costs and also radiation exposure for patients. So we’re pretty excited about that as well.
Gamble: Yeah, that sounds really interesting and that’s something that I want to check back with down the road. Obviously, the fact that it’s vendor-neutral makes a huge difference because a lot of people we’ve talked to are in Epic and you’re never going to get everyone on the same system.