When Rick Skinner took on the role of CIO at UVA Health System last year, he came with a specific goal: to accelerate the academic medical center’s use of analytics. But for Skinner, who had spent four years at Cancer Care Ontario, it was also an opportunity to “return to the front line” in supporting IT. In this interview, he talks about what it was like to go from a single-payer, government-sponsored system in Canada to an academic organization in Virginia, his team’s goals in starting an ACO, and his experience with an integrated record system in the Army 20 years ago. Skinner also discusses UVA Health’s support model with Epic, his patient portal strategy, and his thoughts on population health management.
- About UVA Health
- Epic in hospital & clinics
- Reaching out to Epic to help optimize systems — “There’s a community involved here.”
- Physician builders & associate CMIOs
- 40K MyChart users
- “It has to provide value to the patient.”
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It’s helpful to have people from Epic involved because obviously they have a broader experience than we do with using the system, and can bring to us the practices of their other clients.
Their job is bigger than simply helping their colleagues, but rather helping to configure and reconfigure and enhance the parts of Epic that their particular specialty or service uses.
There’s a community involved here, and it’s not just UVA, and it’s not just Epic — it’s all of us who are trying to change the way our organizations operate, the way our clinicians practice, and the workflow that’s present in our various operating units.
Our objectives with MyChart are to use it for more patient input — things like patient assessments, patient symptom reporting, patient questionnaires, those types of things. We’re just starting to ramp up to do much more of that.
Gamble: Hi Rick, thank you so much for taking the time to speak with us today.
Skinner: You’re welcome.
Gamble: To get things started, can you give us a little bit of background information about UVA Health System, what you have in the way of hospitals, clinics, things like that?
Skinner: The University of Virginia Health System is part of the University of Virginia, a state-sponsored institution. It’s an academic medical center. It consists of the medical center itself, the School of Medicine, the School of Nursing, the faculty practice, which is called University Physicians Group, and the Health Sciences Library, all located in Charlottesville, Virginia.
In addition, we manage and operate probably 80-some odd clinics spread around Central and Southern Virginia outside of Charlottesville, and a dialysis network. Most recently, we started an accountable care organization as of the first of this year, and as of this summer, acquired a community hospital about an hour north of us.
Gamble: What hospital was that?
Skinner: Culpeper Regional Hospital.
Gamble: And that has become official?
Skinner: The agreement is signed. It’s awaiting approval from the attorney general.
Gamble: Okay, so obviously a lot going on there. Now let’s start with the hospitals, as far as clinical application environment goes, you’re on Epic, correct?
Skinner: That is correct. We use Epic in both our hospitals and our clinics. We have a fairly complete implementation of the clinical aspects of Epic. The only pieces we don’t use currently are home health, the OR, and the laboratory modules.
Gamble: Are there plans in place to eventually do that?
Skinner: Yes. We’ll eventually migrate to using those as well.
Gamble: How long has Epic been in place?
Skinner: Almost four years now since our initial implementation, which was a traditional big bang with clinicals.
Gamble: So it’s had enough time where you’re looking more at the optimization phase at this point?
Skinner: For sure. Everybody can spell Epic now, so we are moving on to how best to use Epic. We’ve settled into a support model which seems to be working pretty well. The big focus now is expanding physician support — that is, physicians working part-time as Epic experts, as we call them — to help other physicians to utilize the system more effectively. We’ve also gone through a program with Epic, in Wisconsin, actually, to go through our operation service line by service line and optimize the way we use the system or the way we’ve configured the system. We’ve gone through four already. We’re underway with another four, and we’ll continue until we’ve gone through all of them.
Gamble: And that’s something that’s worked out pretty well so far?
Skinner: It has. One, it’s been helpful to just have a focus that, all right, we’re going to go dig into pediatrics and figure out what works and what doesn’t. Two, it’s helpful to have people from Epic involved in that because obviously they have a broader experience than we do with using the system, and can bring to us the practices of their other clients. And three, the clinicians on the frontline really appreciate it because there’ve been a number of changes that make their lives easier.
Gamble: That’ a pretty cool thing, especially since you’re talking about the people who know the system that well. Do you have a certain number of folks from Epic who come out to your facilities for this?
Skinner: Yes. They configure a team, and that team comes out and does an initial visit, which in essence is a fact-finding or assessment visit. They go back and compare what they’ve seen and heard here with what they know of obviously their software, but also what other customers of theirs are doing. They make a number or recommendations, and we look at those recommendations and accept or reject them. Then they come back and help us implement the recommendations that we’ve selected.
Gamble: How did that start? How did you get that agreement with them? Did they reach out to you?
Skinner: No. Actually, we reached out to them. At that point it was about three years since we put the system in, and we said we feel the need to optimize our use of it, and we think we need some help. And so we and they worked out this program.
Gamble: Now, as far as the physicians that are offering help to others in the use of the system, how did that come about? Was there a specific training for some of these docs who were the super users?
Skinner: The program started a couple of years ago. The physicians self-selected those who had a bent for this kind of thing. We did some internal training and supported them part-time back in their departments as they worked with their colleagues to improve their colleagues’ use of the system. But now the program has changed a bit in that we have a number of physicians that are appointed as associate CMIOs, and they do this on more of a recurring basis. Their job is bigger than simply helping their colleagues, but rather helping to configure and reconfigure and enhance the parts of Epic that their particular specialty or service uses.
In addition to that, we have started sending physicians who have an interest back to Wisconsin to Epic to learn how to be physician builders so that they can actually build documents and flow sheets and so on in Epic. Now, to be honest, it’s not that we expect the docs to take the place of our Epic analyst, but the knowledge they gain by knowing in a much deeper way how Epic works, helps them to help us to enhance the system.
Gamble: It certainly makes sense. It’s all about sharing best practices and being able to get the most possible use out of the system.
Gamble: Epic certainly has as much to gain as you do, it seems.
Skinner: There’s a community involved here, and it’s not just UVA, and it’s not just Epic — it’s all of us who are trying to change the way our organizations operate, the way our clinicians practice, and the workflow that’s present in our various operating units, using a common toolset, Epic, in this case, to help us. Taking advantage of the fact that we are, in essence, a community, is extremely helpful.
Gamble: And you have Epic MyChart, the patient portal?
Skinner: We do.
Gamble: What type of traction are you seeing with that?
Skinner: We started out slowly in that we made available pretty generic things like notice of appointments — not scheduling of appointments, but rather just the notice you had one, email communication with your clinician, and posting of after-visit summaries. And then a little over a year ago, we came to grips with our policy for releasing outpatient results and documentation and began to do that — radiology results, laboratory results, consults, etc. We just recently have come to agreement about the release of inpatient information, things like discharge summaries, operative notes, and that kind of thing. So all of that is available to patients through MyChart.
Gamble: I would guess that it’s something where there was a lot of concern and maybe some hesitation about releasing that information.
Skinner: Definitely a religious argument.
Gamble: Was that something that went on for a while and went back and forth?
Skinner: For sure. You can imagine in an academic medical center with a very diverse population of clinicians and lots of different viewpoints on this, in addition to the fact that a large proportion of our documentation is generated by our learners or house staff, and so it isn’t necessarily generated for consumption by a patient. We had to sort through a lot of that, but I think we’ve arrived at a good place. We have some 40,000 people using MyChart, so it’s been successful. Our objectives in the near term with MyChart are to use it for more patient input — things like patient assessments, patient symptom reporting, patient questionnaires, those types of things. We’re just starting to ramp up to do much more of that through MyChart.
Gamble: I would imagine it’s one effort to get patients educated about it and to sign up for it, but then you want to keep them engaged and have them using it on a more consistent basis.
Skinner: That’s exactly right, and in order to that, obviously, it has to provide value to the patient. What’s in it provides value to the patient. I can get my lab results or whatever it is, but also how my clinician uses it may or may not add to the value of MyChart. So if my physician, for instance, communicates with me regularly on MyChart, and during an office visit says, “Now, remember, go check your results. They’ll be on MyChart tomorrow,” it all facilitates the value that the patient perceives from having MyChart.