As one of the regional CIOs at Vanguard Health, Kristin Darby is tasked with guiding the IT strategy for seven hospitals located in the Chicago and Boston areas. It’s a role that requires a lot of juggling, and constant communication — which Darby facilitates through “huddle meetings” with the staff. In this interview, she talks about the work her team is doing to enable data flow between facilities, increase patient engagement, and lay the groundwork for ACOs. Darby, who was named one of Boston Business Journal’s Top 40 Under 40 in 2010, also discusses the key advantages in being part of a large system, the changes she is seeing in physician acceptance of EHRs, and why community involvement is so important to her.
- About Vanguard Health
- Splitting time between 2 cities
- Meditech (MA) & McKesson (IL) in the hospitals, athenaClinicals in ambulatory
- Best of breed vs standardization
- Connecting with 23 different EMR systems — “You can see the connectivity challenges.”
- EHR adoption trends
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I tend to be here more, but certainly try to split my time 50/50, and also leverage video conferencing as much as possible to ensure there’s a presence at both locations.
The focus is on making sure that when a physician sends their patient to our facility, they’ve got full visibility into the care the patient is receiving, and then when they’re discharged, making sure the continuity of care document is sent to the physician in a timely manner.
The approach has been to go with best of breed, but it does create a challenge with making sure that information is flowing effectively for our providers. There’s never 100 percent data exchange, so our goal from a technology perspective is to make sure that clinicians don’t have blinders on.
You might be looking at a facility that just finished an EMR implementation a year ago or two years ago, and to take something like that on certainly is a large investment — not only from a monetary perspective, but also from a staffing resource perspective.
The perspective of the providers is really evolving, and I think a lot of that is related to some of the changes that have been coming with healthcare reform, ACOs, and risk contracting — all those different factors are playing into the need for providers to have real-time information.
Gamble: Hi Kristin, thanks so much for taking the time to speak with us today.
Darby: Thank you for having me. I’m glad to be here.
Gamble: Just to give our readers and listeners some background, can you tell us a little bit about Vanguard Health System?
Darby: Vanguard Health System is based out of Nashville and has 28 hospitals across the United States. The presence is primarily in Texas, Arizona, Illinois, and Massachusetts, and I am responsible for the Chicago market and the New England market. It is a for-profit organization and has 28 hospitals, but we also have ACOs, health plans, and many other services supporting the hospitals, such as cancer centers, wellness centers, and physical therapy centers to really support our patients, whether they’re in the acute setting or as part of their transition from our facilities.
Gamble: How many of the hospitals fall under your purview in the New England and Chicago markets?
Darby: In Massachusetts, we have three hospitals: St. Vincent’s Hospital in Worcester, which is an academic center serving the Central Mass area, and then we have a MetroWest location, which has Framingham Union Hospital and Leonard Morse. We have about 552 beds amongst those three and they are Meditech facilities. In Illinois, we have four hospitals: West Suburban, Westlake, MacNeal and Weiss. There are teaching programs at MacNeal and Weiss, and about 1,243 beds there, and those facilities are operating on McKesson.
Gamble: How does the reporting structure work with Vanguard? It’s a little bit different from most of the systems and CIOs that we speak to so, I just wanted to clear up how that works.
Darby: Absolutely. I’m considered a Regional Chief Information Officer and my role reports into the President of this region, Erik Wexler. He’s responsible for Illinois and New England, which currently consists of Massachusetts, but we are focused on growing that market and will expand throughout New England. And then I have a dotted line reporting relationship to the corporate CIO based in Nashville.
Gamble: How do you split your time geographically?
Darby: I try to have a presence in both markets equally, but I do live in Massachusetts, in the Boston area. I tend to be here physically more, but certainly try to split my time 50/50, and also leverage video conferencing as much as possible to ensure there’s a presence at both locations whenever I’m unable to be physically present.
Gamble: Do you have to spend some time in Nashville as well?
Darby: Not so much. We really focus on trying to have most of our presence and all of our corporate meetings out in the markets where we have hospitals, and so we tend to meet in different markets versus in Nashville. I like Nashville a lot, but I don’t frequently visit there.
Gamble: It’s enough I’m sure to split the time between Chicago and Boston.
Darby: Absolutely. It definitely has a busy schedule with it, but I enjoy it. Both are wonderful areas to visit. Downtown Chicago is beautiful, as is Boston. They’re two good cities to split my time between.
Gamble: You said that the Massachusetts hospitals are on Meditech. As far as the physician practices, let’s start with the Boston area or the Massachusetts market. Do you have practices that are owned by the system or affiliated?
Darby: We do. In Massachusetts, we have clinics and physician offices. I’ve got 21 locations there, 13 of those being practice sites under St. Vincent’s and nine under Metro West and they operate athenaClinicals. For our physician offices across Vanguard, we are standardized on athenaClinicals.
Gamble: As far as the Chicago area, you said the hospitals are on McKesson?
Darby: That’s correct. McKesson Horizon.
Gamble: What about the physician practices?
Darby: They are also leveraging athenaClinicals.
Gamble: And is there a fairly strong data flow between the hospitals and practices and among the hospitals?
Darby: There is. Certainly there are always opportunities for improvement, but we’ve been heavily focused on expanding our health information exchange platform, both within our hospital facilities and also with our physician offices. I’ll talk about Massachusetts first. We do not have standardization of Meditech across the hospital. For example, we use MedHost in our EDs. We leverage GE Centricity in our Center for Women and Infants Labor Delivery area. I have one critical care unit operating MetaVision out of St. Vincent’s. So within the hospital we have a lot of integration between applications.
We’ve also been focusing on expanding that exchange throughout our external environment, both with physician practices that are owned as part of the Vanguard family, and also externally to our provider community that leverages the hospital. The focus is really on making sure that when a physician sends their patient to our facility, they’ve got full visibility into the care the patient is receiving, and what’s happening based on significant events or events that we’ve chosen to communicate based on feedback from our provider community. And then when they’re discharged, making sure the continuity of care document is sent to the physician in a timely manner and that there’s full transparency between what’s happened in the acute setting and what will happen post-discharge to ensure that the patient receives optimal care.
Gamble: As far as having the different systems in the hospital, you talked about not just having obviously like Meditech throughout. Is that something that does present challenges? Is it something that down the road you could see going to one system?
Darby: I will say that I think historically, it was very much a best-of-breed selection process, and there are certainly benefits with operating some of these applications because sometimes you get functionality with selecting a best-of-breed per department that you may not be able to leverage with an EMR being standardized. Some are stronger in OR areas, some are stronger in ED, and some are stronger in some of the general inpatient functions that cross all departments. The approach has really been to go with best of breed, but it certainly does create a challenge with making sure that information is flowing effectively for our providers within the hospital setting. There’s never 100 percent data exchange, so our goal from a technology perspective is to make sure that clinicians don’t have blinders on. We’re working with them closely to understand if they are seeing everything they need that is important information at the time of care that you need it, and not crossing over. We have a heavy focus on remedying those situations. We’ve made a lot of improvements over the last year; we’re still not 100 percent there, but that continues to be a focus of ours. Every organization, I think, looks at whether or not standardizing on one system is the best way to go. There are certainly advantages to that, and you make those decisions.
We’ve grown a lot over the years as an organization through acquisitions, and so that creates the additional challenge of constant integration. Implementing an EMR is a lot for the hospital to take on and for the provider community to go through. Sometimes you might be looking at a facility that just finished an EMR implementation a year ago or two years ago, and to take something like that on certainly is a large investment — not only from a monetary perspective but also from a staffing resource perspective. So these things get weighed back and forth to determine what that long-term strategy is. We certainly haven’t made a commitment to standardizing on a single EMR within our organization, but it’s definitely something we’ve talked through as part of one of the long-term strategies we want to consider.
Gamble: Looking at the Chicago hospitals, is it a similar situation? You said you have McKesson, but are there also other systems being used?
Darby: They use McKesson throughout the facility predominantly, with the exception of GE within the labor and delivery areas and then athenaClinicals in the physician offices.
Gamble: As far as the physician offices, they also have both owned and affiliated practices?
Darby: That’s correct. The affiliated practices have a variety of EMRs. I don’t know the exact figure for the Illinois market, but in Massachusetts, of the physicians that utilize our three hospitals here I’ve got 23 different EMRs with affiliated practices, so you can see the connectivity challenges. I am happy to say in the Massachusetts market, we have electronic connectivity with 83 percent of those physicians that utilize our facilities, which I think is very impressive, but also very common in Massachusetts. We’re not at that level of penetration within the Illinois market but we certainly are striving to make large increases in that area from a data exchange perspective over the next year.
Gamble: It’s something that’s obviously an ongoing effort, because you’re talking about these entities that you have little or no control over, so I can see that being an ongoing challenge.
Darby: Absolutely. I will say that the perspective of the providers is really evolving, and I think a lot of that is related to some of the changes that have been coming with healthcare reform, the increase in ACOs, and risk contracting — all those different factors are really playing into the need for providers to have real-time information flowing about their patient community. That has required the utilization of electronic information, because there’s so much of it. It’s much easier to manage a problem list or workflow list within an EMR than it is to receive faxes that have to be manually processed in the office and understand what to react to in much more of a manual area. So I think physician offices have been very receptive to getting electronically connected and working with us to make sure they understand and are receiving the value of that data exchange coming through from an electronic perspective.